Clinical Outcomes of Candida auris Versus Other Candida Species Bloodstream Infections: An IPTW-Adjusted Cohort Study in South Korea

초록

Candida auris has emerged as a multidrug-resistant, healthcare-associated pathogen worldwide; however, outcome data on C. auris candidaemia in East Asia remain limited. We conducted a retrospective cohort study of adult patients with candidaemia who received antifungal therapy at a tertiary hospital in Seoul, Republic of Korea, from January 2023 to December 2024, comparing C. auris with other Candida species. Confounding was addressed by inverse probability of treatment weighting (IPTW) using a five-covariate propensity score (age, Charlson Comorbidity Index, septic shock, ICU admission at antifungal initiation, and concomitant Gram-negative infection). Among 423 patients, C. auris accounted for 6.9% of cases and was uniformly fluconazole non-susceptible, with frequent high-level caspofungin resistance but preserved micafungin and anidulafungin susceptibility. Patients with C. auris were older, with greater comorbidity and more frequent ICU admission at antifungal initiation. After IPTW adjustment, C. auris was not associated with higher 30-day mortality, the primary outcome (adjusted hazard ratio 0.59, 95% CI 0.26-1.32); the wide confidence interval indicates limited precision rather than equivalence, and results were directionally consistent for 90-day and in-hospital mortality and across sensitivity analyses that varied both the comparison cohort and the analytic method. Residual confounding by unmeasured illness severity and limited precision preclude concluding equivalence. Continued surveillance, molecular characterisation, and infection control remain essential.

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