Study identifies factors associated with death in C. auris bloodstream infections
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Key takeaways:
- Candida auris spreads easily in hospitals and is a major source of nosocomial outbreaks.
- A new study identified factors that raise a patient’s risk for death if they have a C. auris bloodstream infection.
A multicenter study identified factors associated with mortality among patients with Candida auris bloodstream infection.
Researchers found that each 1-point increase in Pitt bacteremia score at onset of C. auris bloodstream infection (BSI) was associated with a 19% increased odds of death, and that patients receiving hemodialysis were three times more likely to die, according to results published in Clinical Infectious Diseases.
In the 15 years since C. auris was first described, the frequently multidrug-resistant fungus has emerged as an important cause of nosocomial outbreaks, including in the United States, demonstrating a knack for spreading easily in hospitals.
For the new study, Adriana Jimenez, PhD, MPH, infection prevention manager for the University of Miami Health System, and colleagues retrospectively collected clinical data from adult patients with C. auris who were admitted to three academic health systems in South Florida and one academic health system and county health department in Southern California between Sept. 1, 2017 and Dec. 31, 2022.
The clinical data included “information on demographics, medical comorbidities, presence of invasive medical devices, antifungal susceptibilities, antibiotic and antifungal administration history, documented infectious sources, severity of illness as defined by the Pitt bacteremia score, and clinical outcomes,” Jimenez and colleagues wrote.
The Pitt bacteremia score, which measures the severity of a patient’s acute illness, “has been validated in previous studies for use in severity of illness evaluations for non-C. auris Candida BSIs,” the researchers wrote, but they believe their study was the first to use it to predict mortality in C. auris BSI.
In all, 54.6% of the patients died. According to the analysis by Jimenez and colleagues, baseline Pitt bacteremia score (OR = 1.19; 95% CI, 1.01-1.4 for each 1-point increase) and being on hemodialysis (OR = 3.08; 95% CI, 1.27-7.5) were both associated with mortality among patients with C. auris BSI.
They also found that hemodialysis lowered a patient’s odds of clearing their infection (OR = 0.15; 95% CI, 0.05-0.43).
“These findings should be considered in context [because] the cohort included patients with numerous preexisting comorbidities, indicating an ill patient population,” Jimenez and colleagues wrote.
Given C. auris’ spread, “it is important to better understand risk factors for poor clinical outcomes, some of which are hopefully modifiable with targeted prevention practices,” they wrote. “A targeted infection prevention and control focus ... among vulnerable populations, such as those who are hemodialysis-dependent and have high Pitt bacteremia scores, may prevent healthcare associated fungemia and reduce mortality.”
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