"Prevalence and Risk Factors of Candidozyma auris Colonization Among Adult ICU Patients in India: Evaluation of a Real-Time PCR Screening Approach".

PURPOSE: Candidozyma (previously Candida) auris is a multidrug-resistant yeast linked to nosocomial outbreaks in Intensive care units (ICUs); colonization precedes invasive disease and drives transmission. We aimed to determine the prevalence of C. auris colonization among adult ICU patients using real-time PCR and to identify associated risk factors. METHODS: A prospective study was conducted over 18 months (April-2023 to September-2024) in a tertiary-care adult ICU in India. Composite axilla/groin swabs were collected on Day 1 and Day 4 of ICU stay. Samples underwent enrichment broth culture, CHROMagar plating, VITEK 2 identification, and species-specific real-time PCR. Risk factors were evaluated by univariate analysis and multivariable logistic regression. RESULTS: Among 250 patients (500 swabs), colonization rose from 2.4% on Day 1 to 19.2% on Day 4. PCR showed 100% sensitivity and 98.24% specificity versus culture. Significant associations included urinary catheter use, bloodstream and respiratory infections, and prior exposure to meropenem, azithromycin, clarithromycin, and amikacin. In multivariable analysis, meropenem and azithromycin use on Day 1 independently predicted Day-4 colonization. CONCLUSION: C. auris colonization rose eightfold by Day 4; PCR detected more cases than culture, enabling faster infection-control responses. Prior meropenem and azithromycin exposure independently predicted Day-4 colonization, suggesting antimicrobial pressure may contribute, though confounding by illness severity cannot be excluded. These findings support PCR-based surveillance and targeted stewardship to limit transmission.