Factors Associated With Poor Clinical and Microbiologic Outcomes in Candida auris Bloodstream Infection: A Multicenter Retrospective Cohort Study

Abstract

Background: Candida auris has become a growing concern worldwide because of increases in incidence of colonization and reports of invasive infections. There are limited data on clinical factors associated with poor outcomes in patients with C. auris bloodstream infection (BSI).

Methods: We assembled a multicenter retrospective cohort of patients with C. auris BSI from 2 geographics areas in US healthcare settings. We collected data on demographic, clinical, and microbiologic characteristics to describe the cohort and constructed multivariate logistic regression models to understand risk factors for 2 clinical outcomes, all-cause mortality during facility admission, and blood culture clearance.

Results: Our cohort consisted of 187 patients with C. auris BSI (56.1% male, 55.6% age >65 years); 54.6% died by facility discharge and 66.9% (of 142 with available data) experienced blood culture clearance. Pitt bacteremia score at infection onset was associated with mortality (odds ratio [95% confidence interval]: 1.19 [1.01-1.40] per 1-point increase). Hemodialysis was associated with a reduced odds of microbiologic clearance (0.15 [0.05-0.43]) and with mortality (3.08 [1.27-7.50]).

Conclusions: The Pitt bacteremia score at the onset of C. auris BSI may be a useful tool in identifying patients at risk for mortality. Targeted infection prevention practices in patients receiving hemodialysis may be useful to limit poor outcomes.

Keywords: Candida auris; bloodstream infection; infection control; microbiologic clearance; mortality.