Changes in Epidemiology of Candidemia in the United States with a Focus on Candida auris.

BACKGROUND

Candidemia is a common complication in hospitalized and critically ill patients. Nationwide United States (U.S.) data on candidemia risk factors, species, antifungal resistance, and outcomes remain limited. Our objective was to describe candidemia trends from 2015-2024 and identify risk factors for Candida auris candidemia.

METHODS

Retrospective study using the Epic Cosmos database. We analyzed trends in candidemia risk factors and outcomes. 30-day mortality was evaluated using multivariable logistic regression adjusted for age, Elixhauser Comorbidity Index, COVID-19-related hospitalization, ICU-acquired candidemia, and calendar year. We compared characteristics of patients with C. auris vs. non-C. auris candidemia.

RESULTS

A total of 29,454 candidemia cases were identified among 27,926 unique patients; candidemia incidence increased over time (p=0.02). Overall 30-day mortality was 31.5%, and increased significantly over the study period (from 24.7% to 31.8%; p=0.02). There were similar trends in in-hospital mortality (p=0.01) and intensive care unit-acquired candidemia (p=0.03). The proportion of cases involving C. albicans decreased (p=0.05) while C. auris cases increased (p=0.008). Patients with C. auris candidemia were more likely to be Black, have renal failure, and have a higher Social Vulnerability Index (p<0.001 for all comparisons). Fluconazole resistance increased in C. parapsilosis (from 2.5% to 10.8%, p=0.02) and C. tropicalis (from 6.2% to 18.1%, p=0.03).

CONCLUSIONS

Candidemia-associated 30-day mortality increased over the past decade, aligning with a trend toward older, more acutely ill patients developing candidemia. C. auris candidemia was associated with Black race, higher social vulnerability, and renal failure. Overall, our findings highlight concerning nationwide U.S. candidemia trends.