Candida auris infections in ICU patients: risk factors, outcomes, and antifungal resistance patterns

IF 9.3 1区医学 Q1 CRITICAL CARE MEDICINE

Critical Care Pub Date : 2025-07-28 DOI:10.1186/s13054-025-05544-y

Satyajit Choudhury, Kalpana Majhi, Pragati Jena, Sritam Mohanty, Yallawar Nipun Narayan, Pragnya Paramita Jena, Shakti Bedanta Mishra, Sagarika Panda

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Abstract

Candida auris has emerged as a major nosocomial pathogen in intensive care units worldwide due to its multidrug resistance, environmental persistence, and high transmission potential. While several outbreak reports exist, there remains limited comparative data on clinical features, resistance profiles, and outcomes between Candida auris and non-auris Candida candidemia, particularly in Indian ICU settings. This study aimed to evaluate the incidence, risk factors, antifungal resistance, and clinical outcomes of Candida auris bloodstream infections in comparison to non-auris Candida infections among ICU patients. This retrospective cohort study was conducted over four years (January 2020–December 2023) in the ICU of a tertiary care hospital in eastern India. Adult patients (≥ 18 years) with culture-confirmed candidemia were included and stratified into Candida auris and non-auris groups. Demographic, clinical, therapeutic, and microbiological data were extracted. Antifungal susceptibility testing was performed as per CLSI and CDC guidelines. Multivariate logistic regression identified risk factors associated with Candida auris infection. Survival analysis were compared using Kaplan–Meier and Cox regression analysis. Of 267 ICU patients with candidemia, 38 (14.2%) had Candida auris infection. Candida auris patients were older (median age 60 vs. 53 years) and had lower SOFA scores at admission (median 7 vs. 8; p = 0.02). On multivariate analysis, increasing age (OR 1.10, p = 0.0003) and female sex (OR 16.35, p = 0.012) were independently associated with Candida auris infection. Fluconazole resistance was 94.7% in Candida auris isolates, with amphotericin B and echinocandin resistance in 39.5% and 7.9%, respectively. ICU mortality did not differ significantly between Candida auris and non-auris groups (31.6% vs. 34.5%; p = 0.854), and survival analysis showed no statistically significant difference (log-rank p = 0.07). This study highlights the growing burden of Candida auris in intensive care unit settings, demonstrating a substantial incidence without increased mortality compared to non-auris Candida species. Advancing age and female sex emerged as significant independent risk factors, emphasizing the need for continued surveillance and targeted risk assessment in regions where Candida auris is endemic.

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ICU患者的耳念珠菌感染：危险因素、结局和抗真菌耐药性模式

由于具有多药耐药、环境持久性和高传播潜力，耳念珠菌已成为世界范围内重症监护病房的主要医院病原体。虽然有一些暴发报告，但关于耳念珠菌和非耳念珠菌的临床特征、耐药性概况和结局的比较数据仍然有限，特别是在印度ICU环境中。本研究旨在评估ICU患者耳念珠菌血流感染与非耳念珠菌感染的发生率、危险因素、抗真菌耐药性和临床结果。这项回顾性队列研究在印度东部一家三级医院的ICU进行了四年（2020年1月至2023年12月）。纳入培养证实念珠菌感染的成年患者（≥18岁），并将其分为耳念珠菌组和非耳念珠菌组。提取了人口统计学、临床、治疗和微生物学数据。抗真菌药敏试验按照CLSI和CDC指南进行。多因素logistic回归确定了与耳念珠菌感染相关的危险因素。生存率分析采用Kaplan-Meier和Cox回归分析。267例ICU患者中念珠菌感染38例（14.2%）。耳念珠菌患者年龄较大（中位年龄60岁对53岁），入院时SOFA评分较低(中位7分对8分；p = 0.02)。多因素分析显示，年龄（OR 1.10, p = 0.0003）和女性（OR 16.35, p = 0.012）与耳念珠菌感染独立相关。耳念珠菌对氟康唑的耐药率为94.7%，对两性霉素B和棘白菌素的耐药率分别为39.5%和7.9%。耳念珠菌组与非耳念珠菌组ICU死亡率无显著差异(31.6% vs 34.5%；P = 0.854)，生存分析差异无统计学意义（log-rank P = 0.07）。这项研究强调了在重症监护病房环境中耳念珠菌日益增加的负担，表明与非耳念珠菌相比，其发病率很高，但死亡率没有增加。高龄和女性成为重要的独立风险因素，强调需要在耳念珠菌流行的地区继续进行监测和有针对性的风险评估。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Critical Care 医学-危重病医学

CiteScore

20.60

自引率

3.30%

发文量

348

审稿时长

1.5 months

期刊介绍： Critical Care is an esteemed international medical journal that undergoes a rigorous peer-review process to maintain its high quality standards. Its primary objective is to enhance the healthcare services offered to critically ill patients. To achieve this, the journal focuses on gathering, exchanging, disseminating, and endorsing evidence-based information that is highly relevant to intensivists. By doing so, Critical Care seeks to provide a thorough and inclusive examination of the intensive care field.