Impact of Candida auris on Critically Ill Patients: A Three-Year Observational Study in a Greek Intensive Care Unit

Abstract

Candida auris has emerged as a multidrug-resistant yeast implicated in healthcare-associated invasive infections and hospital outbreaks. The aim of the current 38-month period observational study in a multidisciplinary Intensive Care Unit (ICU) was to analyze the epidemiology, potential risk factors, management strategies, and patient outcomes of patients with C. auris. During the study period, 32 patients were identified with C. auris infection (6 patients) or colonization (26 patients) and their clinical characteristics and treatment-related factors were compared. Identification of C. auris isolates was confirmed by MALDI-TOF spectrometry. According to our results, regarding patient-related factors, no significant differences were identified. Regarding treatment-related factors, the proportion of patients already receiving corticosteroids (34.6% vs. 83.3%, p = 0.064) or being on renal replacement treatment (7.7% vs. 33.3%) was higher in infected patients. Median time elapsed from ICU admission to first positive culture was 7 (1-21) days and half of cases were ICU-imported. All strains were resistant to fluconazole and susceptible to echinocandines and amphotericin B. Crude mortality of the study population was 43.75%, similar to other previously reported candidemias. Rapid identification of C. auris, continued surveillance, and infection control practices are important elements for controlling successfully its spread in the hospital setting and for establishing promptly its transition from commensalism to infection.

Keywords: ICU mortality; MALDI-TOF; antifungal resistance; candida auris; intensive care unit; risk factors.

Figure 1

Timeline of 32 C. auris cases in ICU. The blue arrow denotes the period that the ICU has been functioning as a COVID-19 ICU.