Clinical characteristics, treatment strategies, and factors associated with 30-day mortality in Candidozyma auris versus non-auris Candida candidemia: a retrospective cohort study.
- 1Department of Infectious Diseases and Clinical Microbiology, Ankara Etlik City Hospital, Ankara, Turkey. [email protected].
- 2Department of Infectious Diseases and Clinical Microbiology, Ankara Etlik City Hospital, Ankara, Turkey.
- 3Department of Microbiology, Ankara Etlik City Hospital, Ankara, Turkey.
Abstract
Background
Candidozyma auris (formerly Candida auris; C. auris) is an emerging healthcare-associated fungal pathogen characterized by environmental persistence, healthcare transmission, and antifungal resistance. We compared the clinical characteristics, management, antifungal susceptibility profiles, and outcomes of C. auris and non-auris Candida candidemia.Methods
This retrospective single-center real-world cohort included 301 consecutive adults with candidemia, comprising 77 patients with C. auris and 224 with non-auris Candida candidemia. Species identification was performed using MALDI-TOF mass spectrometry. Antifungal susceptibility results were interpreted using applicable EUCAST clinical breakpoints or epidemiological cut-off values, while results without applicable interpretive criteria were reported descriptively. The association between C. auris candidemia and 30-day all-cause mortality was evaluated using a clinically informed multivariable Firth-penalized logistic regression model with multiple imputation. Standardized marginal mortality risks were estimated using g-computation.Results
Patients with C. auris candidemia had longer hospital stays before candidemia onset and more frequent central venous catheter and corticosteroid exposure. Crude 30-day mortality was similar between groups (62.3% vs. 62.5%). After adjustment, C. auris candidemia was associated with higher estimated odds of 30-day mortality, although the confidence interval included the null (adjusted odds ratio, 1.967; 95% confidence interval, 0.954-4.055; p = 0.067). Standardized adjusted mortality was 69.7% for C. auris and 59.3% for non-auris Candida candidemia, corresponding to an adjusted risk difference of + 10.4% points (95% CI, - 0.2 to + 21.3). Older age, higher SOFA score, septic shock, corticosteroid use, and hemodialysis were associated with higher adjusted odds of 30-day mortality. Among C. auris isolates, echinocandin non-wild-type phenotypes were uncommon, whereas elevated amphotericin B MICs were observed in approximately one-third of tested isolates. Fluconazole resistance was frequent among tested C. parapsilosis isolates.Conclusions
C. auris candidemia was characterized by a distinct healthcare-associated exposure profile and antifungal susceptibility pattern. Although crude 30-day mortality was similar between groups, adjusted mortality estimates were higher for C. auris, but remained imprecise and included the null. These findings should be interpreted as associative rather than causal. Larger prospective multicenter studies across diverse healthcare settings are needed to further clarify these findings.
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BibTeX
@article{kuzi2026clinical,
title = {{Clinical characteristics, treatment strategies, and factors associated with 30-day mortality in Candidozyma auris versus non-auris Candida candidemia: a retrospective cohort study.}},
author = {Semanur Kuzi and Gönül Çiçek Şentürk and Gülnur Kul and Aslı Haykır and Nurhayat Yılmaz and Nesibe Korkmaz and Dilek Bulut and Müge Aslan and Göknur Yapar Toros and İrfan Şencan and Emin Ediz Tütüncü},
journal = {BMC infectious diseases},
year = {2026},
month = sep,
doi = {10.1186/s12879-026-14401-4},
url = {https://europepmc.org/article/MED/42958490},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Clinical characteristics, treatment strategies, and factors associated with 30-day mortality in Candidozyma auris versus non-auris Candida candidemia: a retrospective cohort study.
AU - Semanur Kuzi
AU - Gönül Çiçek Şentürk
AU - Gülnur Kul
AU - Aslı Haykır
AU - Nurhayat Yılmaz
AU - Nesibe Korkmaz
AU - Dilek Bulut
AU - Müge Aslan
AU - Göknur Yapar Toros
AU - İrfan Şencan
AU - Emin Ediz Tütüncü
PY - 2026
DA - 2026/09/12
JO - BMC infectious diseases
DO - 10.1186/s12879-026-14401-4
UR - https://europepmc.org/article/MED/42958490
AB - Background Candidozyma auris (formerly Candida auris; C. auris) is an emerging healthcare-associated fungal pathogen characterized by environmental persistence, healthcare transmission, and antifungal resistance. We compared the clinical characteristics, management, antifungal susceptibility profiles, and outcomes of C. auris and non-auris Candida candidemia.Methods This retrospective single-center real-world cohort included 301 consecutive adults with candidemia, comprising 77 patients with C. auris and 224 with non-auris Candida candidemia. Species identification was performed using MALDI-TOF mass spectrometry. Antifungal susceptibility results were interpreted using applicable EUCAST clinical breakpoints or epidemiological cut-off values, while results without applicable interpretive criteria were reported descriptively. The association between C. auris candidemia and 30-day all-cause mortality was evaluated using a clinically informed multivariable Firth-penalized logistic regression model with multiple imputation. Standardized marginal mortality risks were estimated using g-computation.Results Patients with C. auris candidemia had longer hospital stays before candidemia onset and more frequent central venous catheter and corticosteroid exposure. Crude 30-day mortality was similar between groups (62.3% vs. 62.5%). After adjustment, C. auris candidemia was associated with higher estimated odds of 30-day mortality, although the confidence interval included the null (adjusted odds ratio, 1.967; 95% confidence interval, 0.954-4.055; p = 0.067). Standardized adjusted mortality was 69.7% for C. auris and 59.3% for non-auris Candida candidemia, corresponding to an adjusted risk difference of + 10.4% points (95% CI, - 0.2 to + 21.3). Older age, higher SOFA score, septic shock, corticosteroid use, and hemodialysis were associated with higher adjusted odds of 30-day mortality. Among C. auris isolates, echinocandin non-wild-type phenotypes were uncommon, whereas elevated amphotericin B MICs were observed in approximately one-third of tested isolates. Fluconazole resistance was frequent among tested C. parapsilosis isolates.Conclusions C. auris candidemia was characterized by a distinct healthcare-associated exposure profile and antifungal susceptibility pattern. Although crude 30-day mortality was similar between groups, adjusted mortality estimates were higher for C. auris, but remained imprecise and included the null. These findings should be interpreted as associative rather than causal. Larger prospective multicenter studies across diverse healthcare settings are needed to further clarify these findings.
SN - 1471-2334
ER -