Retrospectıve Analysis of Candida Auris Colonization and Infections in The Intensive Care Unit
Abstract
Objective: Candida auris (C. auris) is an emerging multidrug-resistant yeast associated with healthcare-associated outbreaks, particularly in intensive care units (ICUs), and is linked to high mortality. This study aimed to evaluate the incidence of C. auris colonization and infection, clinical outcomes, and risk factors in ICU patients at a tertiary hospital in Türkiye. Methods: This retrospective single-center study was conducted at Kartal Dr. Lütfi Kırdar City Hospital (Istanbul, Türkiye) between March 1 and August 31, 2025. Weekly surveillance screening was performed using combined axilla and groin swabs. Clinical specimens were collected in suspected infections. Identification was performed by MALDI-TOF MS. Demographic and clinical variables were analyzed, and logistic regression was used to identify predictors of 30-day mortality. Results: A total of 38 ICU patients with C. auris detection were included. The mean age was 68.8±15.4 years, and 55.3% were male. Colonization was detected in 60.5% of patients, while 39.5% had infection. The overall incidence of C. auris was 1.6%. Bloodstream infection was the most common infection type (31.6%). The overall 30-day mortality rate was 55.3%. Azole resistance was observed in 80.0% of isolates, amphotericin B resistance in 73.3%, and echinocandin resistance in 13.3%. In multivariable analysis, mechanical ventilation was independently associated with 30-day mortality (OR=19.27,95% CI:1.02–363.48; p=0.04). Conclusions: C. auris infections have become a serious threat in ICUs in recent years. The mortality rate is quite high in this study. Advanced age, high comorbidity scores, mechanical ventilation, central venous catheterization, and broad-spectrum antibiotic use were highlighted as risk factors for C. auris. From a cost-effectiveness perspective, early diagnosis of high-risk patients and targeted preventive strategies may be more appropriate than routine weekly C. auris screening. Early detection of C. auris, implementation of contact isolation, strengthening of environmental disinfection, and review of antifungal treatment strategies are critical in controlling this infection.