Managing Candida auris fungemias: the results of a prospective and international study

Abstract

Candida auris causes hospital outbreaks and life-threatening infections, is recognized as a global health threat, and was designated a priority pathogen by the World Health Organization (WHO). Since the data on C. auris fungemias are quite scarce and limited to small retrospective case series, this international study aimed to prospectively assess patient characteristics, outcomes, and therapeutic approaches. The study, conducted through the Infectious Diseases-International Research Initiative (ID-IRI) platform, involved 34 referral centers. Patients with C. auris candidemia were prospectively enrolled between 15 April 2024 and 15 October 2024. Data on demographics, clinical and laboratory findings, treatment details, and 30-day mortality outcomes were collected. Mortality risk factors were analyzed using univariate tests and stepwise multiple binary logistic regression. The study enrolled 162 patients with a mean Charlson Comorbidity Index of 4.1 +/- 2.2. Overall, 91 patients (56.2%) died. Antifungal susceptibility profiles were fluconazole (13/135, 9.6%), caspofungin (121/133, 91%), micafungin (125/126, 99.2%), anidulafungin (74/76, 97.4%), and amphotericin-B (50/134, 37.3%). Inadequate access to appropriate antifungals (odds ratio [OR] = 11.258; 90% confidence interval [CI]: 1.302-97.310; P = 0.065), the presence of central venous catheters (OR = 3.581; 90% CI: 1.037-12.368; P = 0.090), intensive care unit (ICU) stay (OR = 6.148; 90% CI: 1.977-19.123; P = 0.008), abdominal surgery (OR = 5.077; 90% CI: 1.651-15.610; P = 0.017), deep-seated candidal complications (OR = 4.546; 90% CI: 1.103-18.741; P = 0.079), and decreased platelet counts (OR = 1.004; 90% CI: 1.002-1.006; P = 0.006) were associated with increased mortality. Optimizing therapy for C. auris fungemia involves early strain identification, prompt echinocandin use, surveillance, proper catheter management, effective source control particularly in abdominal surgery, monitoring deep-seated candidal complications, and recognizing thrombocytopenia as a critical warning sign.