P-1946. Candida auris in Metropolitan Atlanta: Risk Factors for Mortality and Microbiologic Persistence

TL;DR

This study examines risk factors for mortality and microbiological persistence in patients with Candida auris bloodstream infections in Atlanta from 2022 to 2024.

Contribution

The study identifies traditional risk factors for mortality in C. auris fungemia and finds microbiological persistence is not linked to higher mortality.

Findings

Traditional risk factors like ICU admission and CVC use are associated with in-hospital mortality.

Microbiological persistence was not linked to increased mortality in multivariable analysis.

Half of patients had microbiological persistence, and CVC use was more common in these cases.

Abstract

Candida auris is a highly transmissible yeast, and invasive infections are associated with high mortality. Using data from the Georgia Emerging Infections Program (GAEIP), we describe the characteristics of patients with C. auris fungemia in metropolitan Atlanta since the first area case was identified in 2022 and describe risk factors for in-hospital mortality and microbiologic persistence.Table 1.Basic demographics and clinical characteristics of patients with C. auris fungemia by microbiological persistence. All values are n (%) unless otherwise specified.Demographics and clinical characteristics according to in-hospital mortality. All values are n (%) unless otherwise specified.

Basic demographics and clinical characteristics of patients with C. auris fungemia by microbiological persistence. All values are n (%) unless otherwise specified.

Demographics and clinical characteristics according to in-hospital mortality. All values are n (%) unless otherwise specified.

The EIP is an active laboratory- and population-based surveillance system through a collaboration with the Centers for Disease Control and Prevention. This study included all patients with C. auris fungemia in the GAEIP catchment area from 2022 - 2024. Only residents of the area were eligible for inclusion and only the incident infection was considered. Clinical characteristics were evaluated for association with microbiological persistence, defined as C. auris in the blood at any time in the 29-days after the incident infection, and for in-hospital mortality. Multivariable regression was performed to assess risk of mortality for patients with microbiological persistence while controlling for ICU admission, central venous catheter (CVC) use, chronic kidney disease, and treatment facility.Table 2.Multivariable regression model examining microbiological persistence and in-hospital mortality.

Multivariable regression model examining microbiological persistence and in-hospital mortality.

Between 2022 and 2024, 116 unique cases of C. auris fungemia were identified. Almost half of patients had microbiologic persistence and half had a CVC in place prior to infection, however this was more prevalent in patients with microbiologic persistence (63.6% v 44.3%, Table 1). In-hospital mortality was 32.8% and did not differ between patients with microbiological persistence and those without (Table 1). Older age, ICU, solid organ malignancy, urinary device or CVC in place, and treatment hospital were associated with in-hospital mortality (Table 2). On multivariable analysis microbiological persistence was not associated with in-hospital mortality, while ICU admission and CVC were (Table 3).

In this analysis of C. auris fungemia in metro-Atlanta, we found that traditional risk factors were associated with mortality. Future studies will examine the relationship of specific antifungals with mortality and microbiologic persistence.

Lucy S. Witt, MD, MPH, MSc, Merck & Co: Grant/Research Support

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