Researchers review the features of hospitalized patients with C. auris infection or colonization in the US

By Bhavana KunkalikarReviewed by Danielle Ellis, B.Sc.Jun 13 2023

In a recent study published in Emerging Infectious Diseases, researchers explored hospitalizations associated with Candida auris infection.

Background

Candida auris (C. auris) is an emerging fungal pathogen that is highly transmissible and often drug-resistant, leading to severe infections. The colonization of the skin by C. auris can result in infection and transmission within healthcare facilities. Clinical cases in the US showed an increase of 95% between 2020 and 2021.

US data related to C. auris is limited to outbreak investigations and case series, with incomplete information on patients' healthcare use, underlying conditions, and outcomes. The study utilized a vast healthcare services database to outline the characteristics of patients hospitalized with C. auris colonization or infection.

About the study

The PINC-A1 Healthcare Database (PHD) is an all-payer database that includes healthcare use, pharmacy, and financial data from over 1,000 hospitals in the United States. Approximately 25% of hospitals have provided laboratory data. All hospitalizations with a C. auris positive culture between 2017 and 2022 were identified.

The team utilized diagnosis codes from the International Classification of Diseases (ICD) 10th Revision, Clinical Modification, to detect underlying conditions and complications. Additionally, billing data was analyzed to identify medical devices. The study also compared features of hospitalizations with and without bloodstream infection (BSI) in C. auris patients.

Results

Almost 192 hospitalizations due to C. auris were recorded across 42 hospitals. Hospitalizations related to C. auris were mainly observed in elderly individuals, male patients, and those who identified as non-Hispanic White. BSI was more common among Non-Hispanic Black patients compared to other races/ethnicities.

Approximately 63% and 48% of the bloodstream and non-bloodstream C. auris hospitalizations had their first positive specimen collected within two days of admission, respectively. Almost 58% of bloodstream C. auris hospitalizations also tested positive with another specimen type. Axilla and urine were the most frequent positive specimen types in non-bloodstream C. auris hospitalizations.

Patients having bloodstream and non-bloodstream C. auris infections had similar underlying conditions and complications, including sepsis, chronic kidney disease, diabetes, and pneumonia. Hospitalizations involving bloodstream C. auris were found to have a higher incidence of tracheostomies and central venous catheters (CVC) compared to those without bloodstream C. auris.

Also, echinocandin usage was more common during hospitalizations for bloodstream infections compared to non-bloodstream infections. Notably, the median time from the first positive culture to echinocandin usage was two days.

Almost 76% of hospitalizations required an intensive care unit stay. Out of these cases, 43% involved the use of mechanical ventilation. The median length of hospitalization was 13 days. The study found that the mortality rate in the hospital was 21%.

Bloodstream C. auris had a crude mortality rate of 47% compared to the non-bloodstream infection rate of 31%. Most hospitalizations for bloodstream infections followed the recommended treatment guidelines for candidemia, which involved the use of echinocandin and a delay in treatment initiation.

The team also noted that the non-Hispanic Black race was associated with C. auris bloodstream infection-related hospitalizations, similar to the non-C. auris candidemia-related hospitalizations.

Conclusion

The study findings indicate that patients with complicated medical conditions are most frequently affected by C. auris infection and colonization. The estimated crude mortality rate, including in-hospital deaths and hospice discharges, was 34%. The statement emphasizes the importance of maintaining public health surveillance and containment efforts for C. auris.