# Candidiasis epidemiology and outcomes including emergence of Candida auris from a large, Southern US metro area: a six-year evaluation

## TL;DR

This study examines the spread and outcomes of candidiasis in a large US city over six years, highlighting the rise of the dangerous C. auris strain.

## Contribution

The study provides detailed regional insights into candidiasis epidemiology and the increasing prevalence of C. auris in a Southern US metro area.

## Key findings

- Candida auris increased significantly from 2% to 5% of cultures between 2018–20 and 2021–23.
- Inpatient mortality was 17%, with hospitalization variables and Candida species predicting mortality and readmissions.
- C. albicans and C. glabrata were the most common species, with 44% and 21% of cultures, respectively.

## Abstract

Invasive candidiasis including candidemia is a common healthcare-associated infections with significant morbidity and mortality. The USA does not have mandatory national surveillance for mucocutaneous or invasive candidiasis which complicates estimation of epidemiology and outcomes. The aim of this project was to describe the epidemiology, mortality, and Candida-associated hospital readmissions in hospitalized patients with Candida species infections.

This secondary database analysis used clinical microbiology data from adults hospitalized at three large health systems (25-hospitals) in the Greater Houston area totaling over 1.6 million hospitalization days per year from 2018 to 2023. Proportion and rates of Candida cultures per 10,000 hospitalization days were calculated. Risk factors for mortality and Candida-associated readmissions were assessed by multivariable logistic regression.

Within the study period, 7514 hospitalized patients aged 64 ± 16 years (mean± standard deviation (SD)) with 10,183 unique Candida cultures were identified. Majority of Candida cultures were nosocomial (59%) with wide variability in mean time to positive culture (9 ± 44 days) after admission. Candida specimens were from blood (32%), abdomen (29%), or mucocutaneous (24%) cultures and most commonly C. albicans (44%) or C. glabrata (21%). C. auris increased significantly from 2% of cultures from 2018–20 to 5% in 2021–23 (p < 0.0001). Length of hospital stay was 21 ± 34 days and inpatient mortality was 17%. Multivariable analyses identified hospitalization variables and Candida species predictive of inpatient all-cause mortality and Candida-associated readmissions after initial hospitalization.

These analyses highlight the significant burden of candidiasis and the emergence of new strains, including C. auris. Ongoing surveillance can refine burden estimates and assess the impact of stewardship and infection control interventions.