ABSTRACT Candida auris has emerged globally as a multidrug-resistant fungal pathogen, posing a significant threat in intensive care units (ICUs) due to its ability to spread rapidly and cause severe infections. Although its global significance is well recognized, data on its epidemiology in Bangladesh remain limited. This study aimed to assess the prevalence, acquisition, and clinical implications of C. auris colonization and bloodstream infection among ICU patients in Dhaka. A cross-sectional exploratory study was conducted from August 2021 to September 2022 in the ICUs of one public and one private tertiary hospital in Dhaka. Patients were enrolled upon ICU admission following informed consent. Skin swabs were collected for colonization screening, and blood cultures were done for suspected sepsis. Follow-up samples were obtained to identify ICU-acquired colonization or infection. Isolates were identified using VITEK-2, and antifungal susceptibility was tested via E-test. Of 372 enrolled patients, C. auris colonization was detected in 7% (27), with 4% (15/372) at enrollment and 9% (12/140) acquired during ICU stay. ICU-acquired colonization was more common in the public hospital (13%; 9/68) than in the private hospital (4%; 3/72). One colonized patient developed a fatal C. auris bloodstream infection, despite empiric antifungal therapy. Colonized patients were significantly more likely to have clinically diagnosed sepsis at the time of enrollment (63% vs 33%; P = 0.002), longer ICU stays (median 8 vs 3 days; P = 0.003), and more frequent use of invasive procedures including central venous catheterization, mechanical ventilation, and urinary catheterization. All isolates were resistant to fluconazole, with 11% demonstrating amphotericin B resistance. This study provides the first systematic documentation of C. auris colonization and infection in Bangladeshi ICUs, highlighting healthcare transmission and the link between invasive devices and colonization. The findings emphasize the urgent need for enhanced surveillance, rapid diagnostics, antimicrobial stewardship, and infection prevention and control strategies to interrupt the spread of this high-risk pathogen. IMPORTANCE Candida auris is an emerging multidrug-resistant fungus that poses a serious global health threat, especially in critical care settings. It can live on the skin without causing illness (colonization) but can also enter the bloodstream and cause severe infections that are difficult to treat and often deadly. Intensive care units (ICUs) are particularly vulnerable because patients are critically ill, frequently receive broad-spectrum antimicrobials, and undergo invasive procedures. In Bangladesh, where surveillance data are limited, understanding the burden of C. auris colonization and infection is crucial for guiding prevention and treatment strategies. Our study provides important evidence from ICUs in Dhaka city, highlighting the presence and clinical impact of this pathogen. By identifying its role in bloodstream infections and documenting colonization rates, this work underscores the urgent need for improved infection prevention practices, antifungal stewardship, and laboratory capacity to control the spread of C. auris in resource-limited settings.
Chowdhury et al. (Thu,) studied this question.