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. 2022 Jun;11(3):1149-1160.
doi: 10.1007/s40121-022-00625-9. Epub 2022 Apr 11.

Candida auris Candidemia in Critically Ill, Colonized Patients: Cumulative Incidence and Risk Factors

Federica Briano #  1   2 , Laura Magnasco #  2 , Chiara Sepulcri  1   2 , Silvia Dettori  1   2 , Chiara Dentone  2 , Malgorzata Mikulska  1   2 , Lorenzo Ball  3   4 , Antonio Vena  1   2 , Chiara Robba  3   4 , Nicolò Patroniti  3   4 , Iole Brunetti  4 , Angelo Gratarola  5 , Raffaele D'Angelo  5 , Vincenzo Di Pilato  3 , Erika Coppo  6 , Anna Marchese  3   6 , Paolo Pelosi  3   4 , Daniele Roberto Giacobbe #  7   8 , Matteo Bassetti #  1   2
Affiliations

Candida auris Candidemia in Critically Ill, Colonized Patients: Cumulative Incidence and Risk Factors

Federica Briano et al. Infect Dis Ther. 2022 Jun.

Abstract

Introduction: Candida auris (C. auris) is an emerging nosocomial pathogen, and a sharp rise in cases of colonization and infection has been registered in intensive care units (ICUs) during the ongoing coronavirus disease 2019 (COVID-19) pandemic. The unfavorable resistance profile of C. auris and the potential high mortality of C. auris infections represent an important challenge for physicians.

Methods: We conducted a single-center retrospective study including all patients admitted to ICUs with isolation of C. auris in any non-sterile body site between February 20, 2020, and May 31, 2021. The primary aim of the study was to assess the cumulative incidence of C. auris candidemia in colonized patients. The secondary aim was to identify predictors of C. auris candidemia in the study population.

Results: During the study period, 157 patients admitted to ICUs in our hospital became colonized with C. auris; 59% of them were affected by COVID-19. Overall, 27 patients (17%) developed C. auris candidemia. The cumulative risk of developing C. auris candidemia was > 25% at 60 days after first detection of C. auris colonization. Seven patients with C. auris candidemia (26%) also developed a late recurrent episode. All C. auris blood isolates during the first occurring episode were resistant to fluconazole and susceptible to echinocandins, while 15 (56%) were resistant to amphotericin B. During late recurrent episodes, emergent resistance to caspofungin and amphotericin B occurred in one case each. In the final multivariable model, only multisite colonization retained an independent association with the development of C. auris candidemia.

Conclusion: Candida auris candidemia may occur in up to one fourth of colonized critically ill patients, and multisite colonization is an independent risk factor for the development of candidemia. Implementing adequate infection control measures remains crucial to prevent colonization with C. auris and indirectly the subsequent development of infection.

Keywords: Candida auris; Candidemia; Candidiasis; Colonization; ICU.

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Figures

Fig. 1
Fig. 1
Cumulative risk of Candida auris candidemia in colonized ICU patients. The risk was estimated by means of the Aalen–Johansen method, with the first occurring C. auris candidemia as the event of interest, death as a competing event, and discharge from the ICU as a right-censoring event. BSI bloodstream infection, ICU intensive care unit
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