Risk factors and antifungal resistance in Candidozyma auris bloodstream infections in Southern China

Abstract

Abstract Background Candidozyma auris , also known as Candida auris , is an emerging multidrug-resistant fungal pathogen that represents a major global health concern; however, its risk factors and antifungal resistance patterns in bloodstream infections (BSIs) in Southern China remain insufficiently characterized. Therefore, this study aimed to identify risk factors and antifungal resistance patterns associated with C. auris BSIs. Methods A retrospective analysis was performed on 137 patients with candidemia at a large tertiary hospital in Southern China between October 2023 and September 2025. Least absolute shrinkage and selection operator regression followed by multivariate logistic regression was used to identify independent risk factors, and antifungal susceptibility testing was performed. Minimum inhibitory concentrations were determined and interpreted in accordance with the Clinical and Laboratory Standards Institute M27-A3 guideline. Results C. auris was identified as the predominant pathogen, accounting for 39.4% (54/137) of candidemia cases, indicating an evident regional predominance and substantial burden. Independent risk factors included hypertension (OR = 6.283, 95% CI: 2.466–17.719), mechanical ventilation (OR = 4.329, 95% CI: 1.585–12.980), use of two or more antibiotics at infection onset (OR = 5.991, 95% CI: 2.349–16.686), and glucocorticoid therapy (OR = 3.100, 95% CI: 1.196–8.509). The 30-day mortality rate associated with C. auris infection was 18.5%. Lower C-reactive protein levels were independently associated with C. auris BSIs (OR = 0.987, 95% CI: 0.978–0.995), potentially reflecting a distinct host inflammatory response rather than representing a predisposing risk factor. Antifungal susceptibility testing revealed universal resistance to fluconazole (100%), while susceptibility to echinocandins was retained. Conclusions This study identified C. auris as an emerging leading cause of candidemia in this region, characterized by different clinical risk factors and high antifungal resistance, highlighting the importance of early identification and targeted infection control strategies.