Candida auris Emerges as Leading Cause of Candidemia

Candidozyma auris bloodstream infections may represent a substantial emerging challenge in Southern China, with new research identifying high rates of fluconazole resistance and several clinical factors associated with infection.

The retrospective study examined 137 patients with candidemia treated at a large tertiary hospital in Southern China between October 2023 and September 2025. Researchers sought to characterise the burden of C. auris bloodstream infections (BSIs), identify factors independently associated with infection, and assess antifungal susceptibility.

The findings showed that C. auris, also widely known as Candida auris, accounted for 54 of the 137 candidemia cases, representing 39.4% of infections. This made it the predominant pathogen identified in the study population.

Clinical Factors Associated With C. auris Infection

Researchers used statistical modelling to identify characteristics independently associated with C. auris BSIs.

Hypertension was associated with more than a six-fold increase in the odds of C. auris infection compared with other causes of candidemia. Use of two or more antibiotics at the time of infection was similarly associated with increased odds, with an odds ratio (OR) of 5.991.

Mechanical ventilation was another significant factor, associated with more than four times the odds of C. auris infection (OR: 4.329), while glucocorticoid therapy was associated with approximately three times the odds (OR: 3.100).

Lower C-reactive protein (CRP) concentrations were also independently associated with C. auris BSIs. However, the researchers cautioned that this finding may reflect differences in the host inflammatory response rather than indicating that lower CRP itself predisposes patients to infection.

The 30-day mortality rate among patients with C. auris infection was 18.5%.

Fluconazole Resistance Reaches 100%

Antifungal susceptibility testing revealed a particularly concerning resistance profile. All C. auris isolates tested were resistant to fluconazole, demonstrating the potential limitations of this commonly used azole antifungal in managing infections caused by the pathogen.

In contrast, susceptibility to echinocandins was retained, suggesting that this antifungal class may continue to provide an important treatment option within the population studied.

The findings are particularly relevant because C. auris is recognised as an emerging multidrug-resistant fungal pathogen capable of causing invasive infections, including bloodstream infections.

Findings Support Targeted Infection Control

The researchers concluded that the high proportion of candidemia attributable to C. auris, combined with its antifungal resistance profile, underscores the importance of rapid pathogen identification and targeted infection control.

Recognition of clinical factors associated with infection could also help identify patients requiring particularly close surveillance. However, as the analysis was retrospective and conducted at a single tertiary hospital, the findings may not represent the epidemiology of C. auris across Southern China more broadly.

Further multicentre surveillance will be important for determining whether the high burden observed in this hospital reflects a wider regional trend and for tracking changes in antifungal resistance over time.

Reference

Yi S et al. Risk factors and antifungal resistance in Candidozyma auris bloodstream infections in Southern China. BMC Microbiol. 2026;DOI: 10.1186/s12866-026-05523-5.