Clinical Characteristics, Antifungal Therapy, and Outcomes of Candida auris Candidemia: A Two-Center Cohort Study.

BACKGROUND: Candida auris has become a growing concern in hospital settings because of its resistance to multiple antifungal drugs. This study investigated the clinical features, treatment patterns, and outcomes of patients diagnosed with C. auris candidemia at two medical centers in Riyadh, Saudi Arabia. METHODS: A two centres, retrospective cohort study which includes adult patients who had positive blood cultures for C. auris. The analysis covered patient characteristics, antifungal treatments, and outcomes. RESULTS: The cohort consisted of 228 cases with C. auris candidemia 51.4% of whom were male. The average age of patients was 61.9± 17.8 years, and common comorbidities included hypertension (59.2%) and diabetes (50.0%). ICU care was needed for 68.8% of the patients. Fluconazole resistance was high (77%), while echinocandins showed >90% susceptibility. Patients who received monotherapy had faster clearance (median = 4; IQR = 3-5) compared to combination therapy (median = 5; IQR = 3.75-8) (p= 0.013). Fewer recurrences were observed in monotherapy (11.1%) compared to those on combination therapy (23.7%) (p= 0.021). Survival was significantly lower among patients with high SOFA scores (p=0.027). CONCLUSION: C. auris candidemia remains a major clinical challenge due to its drug resistance and the severity of illness in affected patients. Echinocandins continue to be the preferred first-line treatments, and using SOFA scores may help in predicting patient outcomes and guiding treatment plans.