Clinical characteristics, treatment strategies, and factors associated with 30-day mortality in Candidozyma auris versus non-auris Candida candidemia: a retrospective cohort study

Candidozyma auris (formerly Candida auris ; C. auris ) is an emerging healthcare-associated fungal pathogen characterized by environmental persistence, healthcare transmission, and antifungal resistance. We compared the clinical characteristics, management, antifungal susceptibility profiles, and outcomes of C. auris and non-auris Candida candidemia. This retrospective single-center real-world cohort included 301 consecutive adults with candidemia, comprising 77 patients with C. auris and 224 with non-auris Candida candidemia. Species identification was performed using MALDI-TOF mass spectrometry. Antifungal susceptibility results were interpreted using applicable EUCAST clinical breakpoints or epidemiological cut-off values, while results without applicable interpretive criteria were reported descriptively. The association between C. auris candidemia and 30-day all-cause mortality was evaluated using a clinically informed multivariable Firth-penalized logistic regression model with multiple imputation. Standardized marginal mortality risks were estimated using g-computation. Patients with C. auris candidemia had longer hospital stays before candidemia onset and more frequent central venous catheter and corticosteroid exposure. Crude 30-day mortality was similar between groups (62.3% vs. 62.5%). After adjustment, C. auris candidemia was associated with higher estimated odds of 30-day mortality, although the confidence interval included the null (adjusted odds ratio, 1.967; 95% confidence interval, 0.954–4.055; p = 0.067). Standardized adjusted mortality was 69.7% for C. auris and 59.3% for non-auris Candida candidemia, corresponding to an adjusted risk difference of + 10.4% points (95% CI, − 0.2 to + 21.3). Older age, higher SOFA score, septic shock, corticosteroid use, and hemodialysis were associated with higher adjusted odds of 30-day mortality. Among C. auris isolates, echinocandin non-wild-type phenotypes were uncommon, whereas elevated amphotericin B MICs were observed in approximately one-third of tested isolates. Fluconazole resistance was frequent among tested C. parapsilosis isolates. C. auris candidemia was characterized by a distinct healthcare-associated exposure profile and antifungal susceptibility pattern. Although crude 30-day mortality was similar between groups, adjusted mortality estimates were higher for C. auris , but remained imprecise and included the null. These findings should be interpreted as associative rather than causal. Larger prospective multicenter studies across diverse healthcare settings are needed to further clarify these findings.