Comparative Clinical Characteristics and Outcomes of Candida (Candidozyma) auris vs. Non-C. auris Candidemia in Non-neutropenic Patients in South India

Abstract

Introduction: Invasive candidiasis is a serious healthcare associated infection with a high mortality rate. Emergence of the multi-drug-resistant species Candida (Candidozyma) auris over the past two decades poses further challenges. We aimed to study the epidemiology, clinical profile and outcomes of non-neutropenic adults with C. auris candidemia in comparison with candidemia due to other species.

Methods: We conducted a retrospective study of all non-neutropenic adult patients admitted to our tertiary care centre with blood culture proven candidemia between January 2019 and September 2024. We retrospectively collected their clinical data and investigation records via hospital's electronic records and document management systems.

Results: Out of a total of 372 candidemia episodes, 85 (22.8%) were caused by C. auris, which was the second most common species after C.tropicalis. The incidence of candidemia overall as well as C. auris candidemia increased during the SARS-COV2 pandemic. In comparison to other species, C. auris candidemia was associated with prolonged hospital stay, prior antifungal exposure, a lower SOFA score and was common in patients on ECMO. Candida endocarditis was associated with persistent candidemia and long, tunnelled lines. C. auris showed 100% resistance to fluconazole and very low rate of susceptibility to amphotericin B: only echinocandins were reliably effective. A negative beta-D glucan (BDG) value was seen in a quarter of patients with both C. auris as well as with other species. Overall survival at 28 days was only 40%. Advanced age and a high SOFA score were associated with higher mortality. C. auris was associated with a lower mortality overall but was not associated with higher mortality in a multi-variate analysis.

Conclusion: Multi-drug-resistant Candida (Candidozyma) auris has emerged as a major nosocomial pathogen in Indian ICUs since the SARS-COV-2 pandemic, especially later in the course of hospital stay and with prior antifungal exposure. A negative BDG result alone cannot be used for withholding or discontinuing antifungals. Echinocandins are the empiric antifungals of choice for candidemia in view of the current epidemiology and resistance profile.

Keywords: Candida (Candidozyma) auris; Beta-D glucan (BDG); Candidemia; Comparative clinical profile.