Study Clinical Characteristics and Outcomes of Candida auris Candidemia in Adult Intensive Care Unit Patients: A 30-Month Retrospective Study

Background: Candida auris (C. auris) has emerged as a multidrug-resistant fungal pathogen causing healthcare-associated outbreaks worldwide, particularly in intensive care units (ICUs). Its environmental persistence, multidrug resistance, and high mortality make it a major challenge for infection prevention and clinical management. This study aimed to investigate the clinical characteristics, clinical exposures, treatment outcomes, and mortality of adult ICU patients with C. auris candidemia during the first 30 months after the opening of a tertiary care hospital. Methods: This retrospective observational study included all adult patients (≥18 years) admitted to five ICUs between 1 July 2020 and 31 December 2022 who developed culture-confirmed C. auris candidemia. Isolates were identified using matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) with the Microflex LT/SH Smart MS system (Bruker Daltonics, Bremen, Germany) according to routine microbiological laboratory procedures. Demographic characteristics, underlying diseases, invasive procedures, clinical exposures, microbiological findings, treatment, APACHE II scores, and clinical outcomes were retrospectively analyzed. Results: During the 30-month study period, 3716 adult patients were admitted to the ICUs, and candidemia developed in 432 (11.6%). Of these episodes, 22 (5.1%) were caused by C. auris. The first C. auris candidemia case occurred 184 days after hospital opening. The mean age was 55 ± 17 years, and overall ICU mortality was 77.3%. Sepsis (36.4%), malignancy (22.7%), and cerebrovascular disease (18.2%) were the most common reasons for ICU admission. All patients had received broad-spectrum antibiotics, whereas central venous catheterization and invasive mechanical ventilation were present in 77.3% of cases. The mean interval from ICU admission to candidemia was 49 ± 15 days. Caspofungin was used as first-line antifungal therapy in all patients. Non-survivors had significantly higher APACHE II scores (32.8 ± 4.9 vs. 26.4 ± 6.6, p = 0.029) and predicted mortality rates (80.1% vs. 53.3%, p = 0.012). Antifungal treatment duration was significantly shorter among non-survivors (p < 0.001), whereas no significant differences were observed in age, ICU length of stay, or time to blood culture clearance. Conclusions: C. auris candidemia was observed in critically ill patients with prolonged ICU stays and frequent invasive interventions and was associated with high all-cause ICU mortality. Higher APACHE II scores were associated with mortality in this cohort, reflecting greater baseline severity of illness. Given the small sample size and descriptive, exploratory nature of the study, these findings should be interpreted with caution. The effectiveness of specific infection-control, diagnostic, or therapeutic interventions was not evaluated. Larger multicenter prospective studies are needed to better characterize the epidemiology, clinical outcomes, and factors associated with mortality in C. auris candidemia.