Managing <i>Candida auris</i> fungemias: the results of a prospective and international study
Hakan Erdem, Sena Şakir-Yildirim, Handan Ankaralı, Ayşe Batırel, Gülnur Kul, Gonca Fidan, Amani El‐Kholy, Abdullah Umut Pekok, Omnia Mohamed Elnabawy Ahmed Taher, Fatma Bozkurt, Yasemin Çağ, Hande Berk, Hülya Çaşkurlu, Esma Eren, Lütfiye Nilsun Altunal, Maha Ali Gad, Gülay Okay, Fatma Amer, Ahmet Doğan, Mehmet Emirhan Işık, Buket Ertürk Şengel, Fahad Almajid, Kumar Angamuthu, Jehan El-Kholy, Abu Hena Mostafa Kamal, Nilgün Karabıçak, Nefise Oztoprak-Cuvalci, Souha S. Kanj, Pınar Yürük Atasoy, Berfin Cirkin-Doruk, Nagwa Mostafa El‐Sayed, Nirav Pandya, Bilal Ahmad Rahimi, Elif Tükenmez Tigen, Mustafa Uğuz, Seniha Şenbayrak, Canan Ağalar, Meli̇ha Çağla Sönmezer, Yeliz Çiçek, Umran Elbahr, İlknur Erdem, Tuba Kuruoğlu, Sibel Kuyugoz-Gulbudak, Aruna Poojary, Ertuğrul Yazici, Tuğrul Hoşbul, Aysun Yalçı, Hanefi Cem Gül
Abstract
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.