Maimonides Evening of Research

Staff Winner

Rosanna Li, PharmD

Mortality And Risk Factors Of Candida Auris Candidemia: Results From A Multicenter Case-Control Study

Objectives

Invasive infections due to Candida auris are associated with high rates of morbidity and mortality. Data comparing outcomes of candidemia caused by C. auris to other Candida species (spp.) are limited.

Methods

We performed a multicenter, retrospective case-control study at three hospitals in Brooklyn, New York between 2016 and 2020. Patients with at least one positive blood culture for Candida spp. who were started empirically on echinocandins within 24 hours of blood culture positivity were included. The primary outcome was 30-day mortality. Secondary outcomes included 90-day mortality, in-hospital mortality, 30-day readmission, and 60-day microbiologic recurrence. Robust inverse propensity score weighting was used to adjust for seven potential confounding variables (age, infection source, Charlson Comorbidity index, septic shock, SOFA score, concomitant invasive gram-negative bacterial infections, and ICU status at the time of antifungal initiation). Baseline characteristics and risk predictors were analyzed using individual logistic regression models weighted with the robust inverse propensity score.

Results

196 cases of candidemia including 83 cases of C. auris candidemia were included in the analysis. The most common species of other Candida spp. was C. glabrata (n=37, 32.7%). Unadjusted 30-day mortality rates were 31.5% in the C. auris group and 40.7% in the control population. After robust inverse propensity adjustment, C. auris candidemia was not associated with greater 30-day mortality (adjusted odds ratio [aOR], 1.014; 95% CI, 0.563–1.828; P=0.963), 90-day mortality (aOR, 0.863; 95% CI, 0.478-1.558; P=0.625), in-hospital mortality (aOR 1.4; 95% CI, 0.787-2.489; P=0.252), or 30-day readmission (aOR, 1.331; 95% CI, 0.58-3.055; P=0.499). There was a greater risk of 60-day microbiologic recurrence in the C. auris group (aOR 4.461; 95% CI, 1.033-19.263; P=0.045). Patients with C. auris fungemia were more likely to have healthcare exposure, known colonization with C. auris and multi-drug resistant bacteria, and certain comorbidities such as cerebrovascular disease, chronic pulmonary disease, and hemiplegia.

Conclusion And Implication

Data suggest candidemia caused by C. auris carries a similar risk of mortality as other Candida spp. but an increased risk of recurrence after the completion of antifungal therapy.