Clinical Outcomes of Micafungin and Anidulafungin in Candidozyma auris (Formerly Candida auris) Candidemia: A Propensity Score-Matched Retrospective Cohort Study

Candidozyma auris (formerly Candida auris) is a critical-priority multidrug-resistant pathogen. Comparative clinical data on first-line echinocandins—micafungin and anidulafungin—in C. auris candidemia remain limited. This retrospective cohort study compared clinical outcomes of micafungin and anidulafungin in adult patients with C. auris candidemia treated between January 2024 and December 2025 at three affiliated hospital campuses in Istanbul, Türkiye. Propensity score matching (PSM) using a 1:1 nearest-neighbor algorithm was performed to balance baseline characteristics. Outcomes included 30-day (primary) and 14-day all-cause mortality, microbiological response, end-of-therapy (EOT) response, relapse, and drug-induced liver injury assessed by the Roussel Uclaf Causality Assessment Method (RUCAM). Among 154 included patients (micafungin, n = 94; anidulafungin, n = 60), no echinocandin resistance was detected. After PSM (55 matched pairs), 30-day all-cause mortality was identical between groups (41.8% vs. 41.8%; mOR 1.00, 95% CI 0.43–2.31; p = 1.000). Fourteen-day all-cause mortality (16.4% vs. 18.2%; p = 0.763), microbiological response (94.5% vs. 90.9%; p = 0.480), EOT response (74.5% vs. 67.3%; p = 0.346), and relapse (12.7% vs. 10.9%; p = 0.763) did not differ significantly between groups. RUCAM-based hepatic safety profiles were descriptively comparable. Micafungin and anidulafungin showed comparable observed outcomes in C. auris candidemia in this cohort.