Abstract Introduction Candida auris is an emerging multidrug-resistant yeast associated with severe infections in critically ill and immunocompromised patients. Diagnostic delays are common in resource-limited settings due to misidentification by conventional systems. Echinocandins remain first-line agents, but resistance and limited access hinder management. We describe four adult cases of C. auris infection or colonization with pulmonary involvement and polymicrobial coinfections, illustrating diagnostic and therapeutic challenges in critical-care environments. Case Presentation Case 1: A 56-year-old man with poorly controlled diabetes and obesity presented with necrotizing fasciitis (LRINEC = 8) and multiple abdominopelvic abscesses. Blood cultures grew MRSA; urine grew Candida tropicalis; and later, abdominal fluid yielded C. auris. He developed pleural effusion, acute kidney injury (creatinine 7.9 mg/dL), and respiratory failure. Despite debridement, meropenem-linezolid, and caspofungin, he deteriorated to septic shock and died on day 59. Case 2: A 37-year-old man with untreated HIV and disseminated tuberculosis presented with 15 days of diarrhea, dyspnea, and fever. Labs showed anemia, leukocytosis, elevated CRP, and hepatic dysfunction. Sputum cultures grew Haemophilus influenzae; later, blood cultures were positive for C. auris. He underwent splenectomy for abscesses and received antituberculous therapy, antiretrovirals, and antifungals. He recovered and was discharged after 167 days. Case 3: A 50-year-old HIV-positive man with disseminated TB (MTB detected in sputum, urine, bone marrow) had a five-month history of asthenia and dyspnea. Bronchial aspirate grew C. auris. Labs showed pancytopenia, severe hyponatremia, and lactic acidosis. Despite caspofungin, ventilation, and anti-TB therapy, he developed multiorgan failure and died. Case 4: A 31-year-old man with advanced HIV (CD4 24/µL) and miliary TB presented with pancytopenia, lactic acidosis, and hypoalbuminemia. Blood cultures revealed C. auris and carbapenemase-producing Klebsiella pneumoniae. He received caspofungin, meropenem, and colistin, with mechanical ventilation but developed refractory septic shock and died. Discussion All patients shared profound immunosuppression, prolonged hospitalization, and broad-spectrum antibiotic exposure—key risk factors for C. auris. Only one survived following early source control. Diagnostic limitations delayed antifungal initiation, underscoring the need for advanced mycology access and training. Echinocandins were used empirically, but outcomes remained poor amid polymicrobial sepsis. These cases demonstrate the intersection of C. auris with tuberculosis and multidrug-resistant bacteria in critically ill adults, emphasizing the importance of antifungal stewardship, infection-control bundles, and regional strengthening of diagnostic capacity. This abstract is funded by: no funding
Briones-Zamora et al. (Fri,) studied this question.