Systematic Review and Meta-analysis of Mortality Comparing Candidozyma auris Candidemia and Non-auris Candida Candidemia

This is the authors' abstract. We don't add key points for this paper.

BACKGROUND: Candidozyma auris (formerly Candida auris) is an emerging multidrug-resistant fungal pathogen associated with high candidemia mortality, but whether its mortality exceeds that of non-auris Candida species remains unclear. METHODS: We conducted a systematic review and meta-analysis comparing all-cause mortality between C. auris and non-auris Candida candidemia (PROSPERO CRD420261355350). Random-effects pooled odds ratios (ORs) with 95% confidence intervals (CIs) were stratified by mortality timepoint, heterogeneity was explored post hoc, and certainty of evidence was assessed using GRADE. RESULTS: Twenty-three observational studies (31,870 total observations; 2,731 C. auris, 29,139 non-auris Candida) were included. Pooled ORs showed no statistically significant difference for 28/30-day mortality (16 studies; crude mortality 40.1% vs 38.2%; OR 0.82, 95% CI 0.66-1.02), 90-day mortality (4 studies; 30.9% vs 33.3%; OR 0.64, 95% CI 0.37-1.10), or other mortality endpoints (11 studies; 35.5% vs 32.2%; OR 0.87, 95% CI 0.68-1.11). Sensitivity analyses were directionally consistent, although omitting single studies changed statistical significance in some analyses, and GRADE certainty of evidence was very low across all outcomes. Exploratory subgroup analyses did not clearly identify a source of heterogeneity in 28/30-day mortality, although pooled ORs varied by region, from 0.60 in Turkey and the Middle East to 1.28 in South Asia. CONCLUSIONS: This meta-analysis provides baseline evidence on C. auris mortality, showing no significant excess compared with non-auris Candida candidemia, although certainty is very low.