A-Z Index × Submit A-Z Index × Submit A-Z Index Search Dropdown × Submit Facebook Twitter LinkedIn Syndicate Emerging Infectious Disease journal ISSN: 1080-6059 Disclaimer: Early release articles are not considered as final versions. Any changes will be reflected in the online version in the month the article is officially released.
Metastatic infection after Candidozyma auris candidemia remains poorly characterized. We retrospectively studied patients with C. auris candidemia at a tertiary hospital in Spain during 2016–2024. Of 108 patients, 24 (22.2%) experienced metastatic infections; endocarditis was most frequent (7.4%), followed by osteoarticular infection, meningitis, and hepatosplenic infection (3.7% each). In multivariable Fine–Gray regression, a cardiac device or prosthetic valve was independently associated with metastatic infection (subdistribution hazard ratio [HR] 2.89 [95% CI 1.21–6.91]), although that association was attenuated in a sensitivity analysis restricted to echocardiographed patients. Persistent candidemia showed a higher, nonsignificant risk for metastatic infection in the day-5 landmark analysis (subdistribution HR 2.67 [95% CI 0.86–8.32]). Metastatic infection was associated with increased deaths in time-dependent analyses at 60 days (adjusted HR 2.21 [95% CI 1.04–4.67]) and 90 days (adjusted HR 2.26 [95% CI 1.09–4.67]). Our findings support echocardiography in patients with intracardiac devices.
Invasive candidiasis, in particular candidemia, is a significant infectious threat, especially among patients in intensive care units (ICUs). It represents between 15%–30% of infections in these units and, despite improvements in diagnosis and treatment, the mortality rate associated remain high, 30%–60% in most series ( 1 , 2 ). In that context, metastatic complication, in which infection spreads through the bloodstream to other organs, plays a key role. The most common manifestations include endophthalmitis, osteomyelitis, hepatosplenic abscesses, meningitis, and endocarditis ( 3 ). Depending on underlying clinical conditions and the screening protocols used, 4%–50% of candidemia cases develop metastatic involvement ( 4 – 7 ), which is frequently associated with increased risk for death and prolonged hospitalization ( 8 ).
Candidozyma auris (formerly Candida auris ) ( 9 ) is an emerging, often multidrug-resistant yeast often associated with nosocomial outbreaks worldwide ( 10 , 11 ). It can colonize patients and healthcare environments. Since its identification in Japan in 2009 ( 12 ), C. auris has been reported on all continents except Antarctica and is often associated with high mortality rates. Most research to date has focused on its antifungal resistance patterns, outbreak dynamics, and infection control measures ( 11 ). However, its ability to cause metastatic complications, such as ocular involvement, endocarditis, osteomyelitis, or hepatosplenic candidiasis, is poorly characterized. Available evidence is largely confined to isolated case reports and small series, in which endocarditis in recipients of left ventricular assist devices and central nervous system infection associated with neurosurgical devices predominate ( 13 – 23 ). A few cohort studies have reported secondary organ involvement in 7.7%–27% of patients with C. auris candidemia, but they rarely specify the spectrum of complications, their predictors, or their outcomes ( 18 – 20 , 22 ). Further investigation is essential to clarify its clini…