# Candida auris as an emerging threat in intensive care units: A single-center retrospective study

## TL;DR

Candida auris is a dangerous fungus causing severe infections in ICU patients, with high mortality and resistance to some antifungal drugs.

## Contribution

This study provides insights into clinical and antifungal resistance patterns of Candida auris in ICU patients at a single hospital.

## Key findings

- Fluconazole resistance was detected in 60% of Candida auris isolates.
- Echinocandins remained effective as first-line therapy against Candida auris.
- Delayed detection and limited access to reference susceptibility testing hindered infection control efforts.

## Abstract

•Candida auris causes high mortality in critically ill patients in the intensive care unit.•Fluconazole resistance is frequent, and echinocandins remain active.•Delayed detection impairs effective infection control.•Prolonged intensive care unit stay and invasive care drive acquisition.•Enhanced surveillance is essential to limit hospital spread.

Candida auris causes high mortality in critically ill patients in the intensive care unit.

Fluconazole resistance is frequent, and echinocandins remain active.

Delayed detection impairs effective infection control.

Prolonged intensive care unit stay and invasive care drive acquisition.

Enhanced surveillance is essential to limit hospital spread.

Candida auris is an emerging multidrug-resistant fungal pathogen associated with health care–associated outbreaks, particularly, in intensive care units, and is increasingly recognized as a cause of invasive bloodstream infections worldwide.

This retrospective single-center study analyzed C. auris isolates obtained from blood cultures of 31 patients admitted to the mixed intensive care units of a tertiary multidisciplinary training and research hospital between December 2021 and December 2024. Demographic characteristics, underlying comorbidities, antifungal susceptibility profiles, treatment strategies, and in-hospital outcomes were systematically evaluated using hospital information system records.

The median age was 61 years (range, 21-87), and 55% were male. Fluconazole resistance was detected in 60% (18 of 30) of isolates. Automated susceptibility testing indicated elevated amphotericin B minimum inhibitory concentration values in all isolates; however, the reliability of automated methods for amphotericin B testing in C. auris remains controversial. All isolates remained susceptible to caspofungin and micafungin, and voriconazole susceptibility was inferred based on fluconazole minimum inhibitory concentration values. Echinocandins were used as first-line therapy. In eight (25.8%) patients, C. auris was identified in blood cultures after patient death.

After the identification of C. auris, this institution implemented enhanced infection control measures, including contact isolation, environmental decontamination, and reinforcement of antifungal stewardship. Despite these interventions, delayed detection and limited access to reference susceptibility testing remained major challenges. These findings highlight the need for strengthened active surveillance, rapid diagnostic capacity, and standardized susceptibility testing to reduce nosocomial transmission and improve clinical outcomes in high-risk intensive care settings.