Candida auris candidaemia in an intensive care unit - Prospective observational study to evaluate epidemiology, risk factors, and outcome
Abstract
Purpose To determine the prevalence of Candida auris candidaemia in our ICU patients and its molecular epidemiology. Methods A prospective observational study was conducted on candidaemia in our ICU patients over 18 months during 2016-2017. Demographics, underlying disease, risk factors, antifungal therapy and outcome were studied. Risk factors of C. auris and non-auris candidaemia were compared. Results During the study period, among 108 candidaemia cases recorded, the incidence was 6.75/1000 ICU bed days. C. auris topped the list (n = 42, 39.9%), followed by C. tropicalis (34.3%), and C. parapsilosis (15.7%). On bivariate analysis prior antibiotic therapy, long central line days, mechanical ventilation and length of ICU stay were significant risk factors for C. auris candidaemia compared to non-auris candidaemia. Multivariate analysis showed underlying respiratory and neurological diseases as significantly associated with risk of C. auris candidaemia. Fluconazole, amphotericin B, and caspofungin resistance were noted in 97.0%, 93.7% and 3% of C. auris isolates respectively. Conclusion Longer duration of central line days, prior antibiotic use, mechanical ventilation and prolonged ICU stay were important risk factors associated with C. auris candidaemia along with underlying respiratory or neurological disease. The isolates are non-clonal in origin, but they belong to a single clade.
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C. auris preferentially colonizes the human skin, leading to nosocomial transmission and outbreaks of systemic fungal infections.
“Unlike other Candida species, such as Candida albicans that colonizes the intestinal tract, C. auris preferentially colonizes the human skin, leading to nosocomial transmission and outbreaks of systemic fungal infections [6–8].”
From The Emerging Fungal Pathogen Candida auris Induces IFNγ to Colonize the Skin (2025) · cites this paper as [7]
C. auris colonizes the human skin long-term, leading to nosocomial transmission and outbreaks of skin systemic infection.
“C. auris colonizes the human skin long-term, leading to nosocomial transmission and outbreaks of skin systemic infection [6,7].”
From The Emerging Fungal Pathogen Candida auris Induces IFNγ to Colonize the Skin (2025) · cites this paper as [7]
Unlike other Candida species, C. auris colonizes human skin, leading to nosocomial transmission and outbreaks of invasive fungal infections.
“Unlike other Candida species which colonize in the intestine, C. auris colonizes the human skin, which leads to nosocomial transmission and outbreaks of invasive fungal infections (4 – 6).”
From Differential skin immune responses in mice intradermally infected with <i>Candida auris</i> and <i>Candida albicans</i> (2023) · cites this paper as [5]
C. auris preferentially colonizes the skin.
“Although C. auris preferentially colonizes the skin, the innate immune cells involved in the cutaneous host response against C. auris had not been defined to date.”
From Differential skin immune responses in mice intradermally infected with <i>Candida auris</i> and <i>Candida albicans</i> (2023) · cites this paper as [5]
C. auris colonizes the human skin, which leads to nosocomial transmission and outbreaks of skin infection and candidemia.
“C. auris colonizes the human skin, which leads to nosocomial transmission and outbreaks of skin infection and candidemia (4, 5).”
From Differential skin immune responses in mice intradermally infected with <i>Candida auris</i> and <i>Candida albicans</i> (2023) · cites this paper as [5]
C. auris preferentially colonizes and persists in human skin tissue.
“Candida auris is an emerging multidrug-resistant fungal pathogen that preferentially colonizes and persists in skin tissue”
C. auris has a unique ability to colonize and persist in human and murine skin long term, resulting in nosocomial transmission and outbreaks of systemic infections.
“Unlike other Candida species, such as Candida albicans, that colonize the intestine, C. auris has a unique ability to colonize and persist in human and murine skin long term, resulting in nosocomial transmission and outbreaks of systemic infections (4–8).”
From Cell aggregation mediated by <i>ACE2</i> deletion in <i>Candida auris</i> modulates fungal colonization and host immune responses in the skin (2024) · cites this paper as [6]
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“C. auris colonizes the human skin, which leads to nosocomial transmission and outbreaks of skin infection and candidemia (4, 5).”
BackgroundBalakumar, A., Das, D., Datta, A., Mishra, A., Bryak, G., Ganesh, S. M., Netea, M. G., Kumar, V., Lionakis, M. S., Arora, D., et al. (2024) · PLOS Pathogens · doi:10.1371/journal.ppat.1012699 · Cited by 25 · see citing works
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The Emerging Fungal Pathogen Candida auris Induces IFNγ to Colonize the Skin
Das, D., Ganesh, S. M., Mishra, A., Netea, M. G., & Thangamani, S. (2025) · PLOS Pathogens · doi:10.1371/journal.ppat.1013114 · Cited by 18 · see citing works
Balakumar, A., Cox, A., & Thangamani, S. (2024) · mSphere · doi:10.1128/msphere.00734-24 · Cited by 12 · see citing works
- Authors
- Shastri, P. S., Shankarnarayan, S. A., Oberoi, J., Rudramurthy, S. M., Wattal, C., & Chakrabarti, A.
- Affiliations
- Sir Ganga Ram Hospital (IN)
- Post Graduate Institute of Medical Education and Research (IN)
- Corresponding author
- Shastri, Prakash S.
- ORCID
- Venue
- Journal of Critical Care
- Publisher
- Elsevier BV
- Published
- 2020-06
- Volume
- 57
- Pages
- 42-48
- ISSN
- 0883-9441 (ISSN-L)
- OpenAlex
- W2999456531
- Cited by
- 103
- References
- 3
- Citations by year
- 2026: 12 · 2025: 21 · 2024: 19 · 2023: 18 · 2022: 15 · 2021: 13 · 2020: 5
- FWCI
- 1.68
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Critical Care (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Yeasts and Rust Fungi Studies
- Health Sciences › Medicine › Ophthalmology › Ocular Infections and Treatments
- Keywords
- Candida auris, candidemia, intensive care unit, risk factors, molecular epidemiology, Candida tropicalis, Candida parapsilosis, antifungal resistance, fluconazole resistance, amphotericin B resistance, caspofungin, prior antibiotic use, mechanical ventilation, ICU length of stay, respiratory diseases, neurological disorders, clonal origin
- MeSH terms
- Adult, Aged, Amphotericin B, Antifungal Agents, Candida, Female, Humans, Intensive Care Units, Length of Stay, Male, Middle Aged, Phylogeny, Prospective Studies, Respiration, Artificial, Risk Factors, Fluconazole, Incidence, Prevalence, Treatment Outcome, Amplified Fragment Length Polymorphism Analysis, Candidemia, Molecular Typing
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