Retrospective Analysis of the Clinical Characteristics of Candida auris Infection Worldwide From 2009 to 2020

Abstract

Introduction: Candida auris is an emerging multidrug-resistant fungus that may cause infections with a high mortality rate. The first case of C. auris infection was reported in 2009 and infections have been reported in 44 countries. The fungus now represents a major global public health threat. We analyzed cases from the emergence of C. auris infections up until the end of 2020. It is hoped that the results of this analysis will raise awareness in scientists to promote protection and control research pertaining to this pathogen.

Methods: PubMed and Web of Science databases were searched for all papers related to C. auris infections up until December 31, 2020. We sorted and organized these data into the following categories: date of publication, patient age and sex, underlying diseases, risk factors for infection, patient mortality information, drug sensitivity information of C. auris isolates, and genetic classification. The χ² test was used to screen for factors that may affect patient mortality.

Results: A total of 912 patients were included in the analysis. There's a higher proportion of men and a high proportion of patients were premature babies and elderly people. The proportions of patients with underlying diseases such as diabetes, kidney disease, trauma, and ear disease were also high. More than half of patients had a history of central venous catheter use and a history of broad-spectrum antibiotic use. The χ² test revealed that only kidney disease (P < 0.05) was an important risk factor for mortality in C. auris-infected patients.

Conclusions: A comprehensive understanding of C. auris was achieved following this retrospective analysis, including the characteristics of C. auris-infected patients. In recent years, increasing numbers of multidrug-resistant C. auris isolates have been identified, and the high mortality rates associated with infection merit greater attention from the medical world.

Keywords: Candida auris; drug resistance; infection characteristics; risk factor for mortality; underlying disease.

FIGURE 1

Date of first reports and Candida genetic classification based on the country of origin including South Asia (clade I), East Asia (clade II), South Africa (clade III), and South America (clade IV). In 2018, the highest number of countries reported infection for the first time. Clade I was reported in 17 countries, clade III was reported in eight countries, clade II was reported in five countries, and clade IV was reported in three countries.

FIGURE 2

Sex and age distribution of patients included in the analysis. (A) Sex distribution: males (61.4%) and females (38.6%). (B) Age distribution: 0–18 years (16.5%), 19–44 years (11.8%), 45–59 years (24.0%), and ≥60 years (47.7%). Male patients and older patients are more susceptible.

FIGURE 3

Drug resistance of Candida auris isolates. (A) Drug resistance of Candida auris against eight common antifungals. The isolates had severe resistance to azoles and amphotericin B, and low resistance to echinomycin. (B) Drug resistance of Candida auris isolates. MDR: multi-drug resistance. S: sensitive, R1-R6: drug resistance status. Isolates had severe multidrug resistance, with some isolates exhibiting resistance to six antifungal agents.