Risk Factors and Outcomes for Invasive Infection Among Patients Colonized with Candidozyma auris: A Case–Control Study

Background: Candidozyma auris has emerged globally as a multidrug-resistant pathogen with high rates of colonization and potential for invasive infection. Understanding the progression from colonization to infection and associated outcomes is limited. This study aimed to describe the characteristics and outcomes of C. auris-colonized patients and identify risk factors for progression to infection. Methods: We conducted a single-center retrospective case–control study of hospitalized patients with documented C. auris colonization at a tertiary care center (2018–2024). Cases were patients who progressed to a fungal infection (infection group), while controls remained colonized (colonized group). Demographics, comorbidities, device use, prior antimicrobial exposure, microbiologic characteristics, and outcomes were compared. Results: Among 334 C. auris-colonized patients, 44 (13.2%) progressed to infection. The median age was 66.4 years. Those in the infection group had higher Charlson Comorbidity Index (5.9 ± 3.1 vs. 4.79 ± 2.7, p = 0.0112) and were more likely to have central line (90.9% vs. 71.7%, p = 0.0067), mechanical ventilation (77.3% vs. 60.34%, p = 0.0306), parenteral nutrition (6.82% vs. 1.72%, p = 0.0395), and abdominal surgery (13.64% vs. 4.83%, p = 0.0217). In multivariate analysis, abdominal surgery was the only independent predictor of infection (OR 4.08; 95% CI 1.1–15.1; p = 0.03). In-hospital mortality was significantly higher in the infection group (65.9% vs. 33.1%, p < 0.0001). Conclusions: Approximately one in eight colonized patients developed C. auris infection. Recent abdominal surgery independently predicted progression, while infection was associated with higher mortality and prolonged hospitalization, underscoring the need for targeted prevention in high-risk patients.