30-day mortality and antifungal resistance in confirmed Candida auris bloodstream infections (BSI): a systematic review and meta-analysis.

IF 3.9 2区医学 Q1 INFECTIOUS DISEASES

Infection Pub Date : 2026-10-03 DOI:10.1007/s15010-026-02983-9

Muhammad Kamran, Muhammad Ali, Afreenish Amir, Naseer Ali Shah

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引用次数: 0

Abstract

Background: Candida auris is a potentially multidrug-resistant nosocomial fungus that was classified as a WHO critical priority pathogen in 2022. Individual cohort studies report 30-day bloodstream infection mortality; however, prior meta-analyses have not restricted their primary pool to confirmed bloodstream infection cases.

Methods: A PROSPERO-registered systematic review and meta-analysis was conducted (CRD420261418844). Studies enrolling patients with confirmed C. auris bloodstream infection and reporting 30-day or in-hospital all-cause mortality were included. Freeman-Tukey double arcsine transformation with DerSimonian-Laird random-effects modelling was applied to all proportion pools. Fluconazole and amphotericin B resistance were combined. Echinocandin resistance was synthesised narratively because of the zero-event problem. Subgroup analyses were pre-specified by geographic region and study designs.

Results: Sixteen studies (N = 1,069 patients; 2016-2026) met the inclusion criteria. Pooled 30-day mortality from 13 studies (N = 813) was 39.6% (95% CI 32.4-47.0%; I² = 75.5%). In-hospital mortality from three studies (N = 256) was 45.1% (95% CI 30.9-59.7). Pooled fluconazole resistance was 95.0% (95% CI 86.7-99.7%; I² = 92.6%). Pooled amphotericin B resistance was 45.5% (95% CI 22.6-69.4%; I² = 97.5%), with extreme heterogeneity driven by clade-specific variations. Echinocandin resistance ranged from 0 to 16% across the individual cohorts. Multinational consortia showed the highest regional mortality estimate (52.4%, 95% CI 41.4-63.3%).

Conclusions: Confirmed C. auris bloodstream infections have a pooled 30-day mortality rate of approximately 40%, along with near-universal fluconazole resistance. Echinocandins remain the first-line therapy, although mortality rates remain high. Susceptibility-guided therapy and enhanced infection control are essential.

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确认耳念珠菌血流感染（BSI）的30天死亡率和抗真菌耐药性：一项系统综述和荟萃分析。

背景：耳念珠菌是一种潜在的多重耐药医院真菌，在2022年被世卫组织列为重点病原体。个体队列研究报告了30天血液感染死亡率；然而，先前的荟萃分析并未将其主要池限制在确诊的血液感染病例中。方法：采用prospero注册的系统评价和荟萃分析（CRD420261418844）。研究纳入了确诊耳念珠菌血流感染并报告30天或院内全因死亡率的患者。将Freeman-Tukey双反正弦变换与dersimonan - laird随机效应建模应用于所有比例池。氟康唑和两性霉素B联合耐药。棘白菌素耐药性是由于零事件问题而被叙述合成的。亚组分析按地理区域和研究设计预先指定。结果：16项研究（N = 1,069例患者；2016-2026）符合纳入标准。13项研究的合并30天死亡率（N = 813）为39.6% （95% CI 32.4-47.0%; 2 = 75.5%）。三项研究（N = 256）的住院死亡率为45.1% （95% CI 30.9-59.7）。氟康唑综合耐药性为95.0% （95% CI为86.7-99.7%;I2 = 92.6%）。两性霉素B耐药率为45.5% (95% CI 22.6-69.4%; I2 = 97.5%)，由支系特异性变异引起的极端异质性。棘白菌素耐药性在个体队列中从0%到16%不等。跨国财团显示出最高的区域死亡率估计（52.4%,95% CI 41.4-63.3%）。结论：确诊的耳念珠菌血流感染的30天总死亡率约为40%，同时几乎普遍存在氟康唑耐药性。棘白菌素仍然是一线治疗，尽管死亡率仍然很高。易感性引导治疗和加强感染控制至关重要。

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

Infection 医学-传染病学

CiteScore

12.50

自引率

1.30%

发文量

224

审稿时长

6-12 weeks

期刊介绍： Infection is a journal dedicated to serving as a global forum for the presentation and discussion of clinically relevant information on infectious diseases. Its primary goal is to engage readers and contributors from various regions around the world in the exchange of knowledge about the etiology, pathogenesis, diagnosis, and treatment of infectious diseases, both in outpatient and inpatient settings. The journal covers a wide range of topics, including: Etiology: The study of the causes of infectious diseases. Pathogenesis: The process by which an infectious agent causes disease. Diagnosis: The methods and techniques used to identify infectious diseases. Treatment: The medical interventions and strategies employed to treat infectious diseases. Public Health: Issues of local, regional, or international significance related to infectious diseases, including prevention, control, and management strategies. Hospital Epidemiology: The study of the spread of infectious diseases within healthcare settings and the measures to prevent nosocomial infections. In addition to these, Infection also includes a specialized "Images" section, which focuses on high-quality visual content, such as images, photographs, and microscopic slides, accompanied by brief abstracts. This section is designed to highlight the clinical and diagnostic value of visual aids in the field of infectious diseases, as many conditions present with characteristic clinical signs that can be diagnosed through inspection, and imaging and microscopy are crucial for accurate diagnosis. The journal's comprehensive approach ensures that it remains a valuable resource for healthcare professionals and researchers in the field of infectious diseases.