Risk factors, antifungal susceptibility, complications, and outcome of Candida auris bloodstream infection in a tertiary care center in the western region of Saudi Arabia

Abstract

Candida auris, an emerging multidrug-resistant fungus species that grows as yeast, causes bloodstream infection, and is associated with high mortality rates. In this study, we identified risk factors associated with C. auris bloodstream infection, antifungal susceptibility pattern, complications, and outcome of the infection. This single-center cross-sectional retrospective study was conducted at King Abdulaziz Medical City, a tertiary care facility in Jeddah, Saudi Arabia, which included all patients 18 years or above who have had one or more blood cultures for C. auris between January 2021 and December 2022. We aimed to identify the risk factors associated with C. auris bloodstream infection, antifungal susceptibility patterns, complications, and outcomes at our center. Forty-six patients with C. auris-positive blood cultures were included. All the patients had healthcare-associated infections. The mean age was 64.67 years, and the majority of patients were male (73.9%). The most common concomitant hospital-acquired infections were skin and soft tissue infections (37%), followed by hospital-acquired pneumonia (34.8%) and intra-abdominal infections (26.1%). The mean total white blood cell count, procalcitonin, and C-reactive protein was 10.5 ± 5.99 × 109/L, 2.63 ± 4.82 μg/L, and 90.3 ± 64.1 mg/L, respectively. Hypertension (73.9%) was the most common comorbidity, followed by diabetes mellitus (58.7%) and renal dysfunction (54.3%). Risk factors associated with C. auris candidemia included antibiotic use (91.3%), especially for >14 days (78.3%), C. auris colonization (60.9%), use of central venous catheters, especially when the catheter was in place for >30 days (80.4%), ICU admission in the last 30 days before C. auris-positive blood culture (93.5%), especially for more than two weeks (76.1%), mechanical ventilation (89.1%), total parenteral nutrition (13%), previous intra-abdominal surgery (30.4%), and immunosuppressive therapy (56.5%). A total of 97.8% of C. auris isolates were resistant to fluconazole and 17.4% were resistant to amphotericin B. Endocarditis and endophthalmitis were reported in one (2.2%) patient each. The all-cause mortality at 30 days was 47.8%. Our study is one of the few studies available globally on C. auris bloodstream infection that investigated risk factors, antifungal susceptibility, complications, and outcomes. A thorough screening and risk assessment strategy should aid infection control, preventing it from becoming a major concern in the future.