Volume 29, Number 7—July 2023
Research Letter
Candida auris‒Associated Hospitalizations, United States, 2017–2022
, Kaitlin Forsberg, Jeremy A.W. Gold, James Baggs, and Meghan Lyman
Table
Characteristics of hospitalizations involving Candida auris, United States, 2017–2022*
| Characteristics | Total, n = 192 | Bloodstream infection,† n = 38 | Nonbloodstream infection,‡§ n = 154 | p value |
|---|---|---|---|---|
| Mean, median age, y (range) |
66.0, 68.0 (21–89) |
61.8, 66.5 (32–86) |
67.0, 68.0 (21–89) |
0.042 |
| Age category, y | 0.264 | |||
| <45 | 22 (11.5) | § | § | |
| 45–64 | 52 (27.1) | 11 (28.9) | 41 (26.6) | |
| >65 |
118 (61.5) |
20 (52.6) |
98 (63.6) |
|
| Sex | 0.193 | |||
| M | 104 (54.2) | 17 (44.7) | 87 (56.5) | |
| F |
88 (45.8) |
21 (55.3) |
67 (43.5) |
|
| Race/ethnicity, n = 186 | 0.022 | |||
| Non-Hispanic Black | 45 (24.2) | 14 (38.9) | 31 (20.7) | |
| All other races/ethnicities¶ |
141 (75.8) |
22 (61.1) |
119 (79.3) |
|
| Payer | 0.483 | |||
| Medicare | 128 (66.7) | 25 (65.8) | 103 (66.9) | |
| Medicaid | 35 (18.2) | § | § | |
| Private health insurance | 20 (10.4) | § | § | |
| Other |
§ |
§ |
§ |
|
| Clinical features | ||||
| Mean, median time from admission to first positive C. auris specimen collection, d (range) | 8.6, 2.0 (1–187) | 8.7, 1.0 (1–53) | 8.6, 3.0 (1–187) | 0.997 |
| Within 2 d | 98 (51.0) | 24 (63.2) | 74 (48.1) | |
| >2 d | 94 (49.0) | 14 (36.8) | 80 (51.9) | |
| Systemic antifungal use on or after first positive C. auris culture | ||||
| Echinocandin | 68 (35.4) | 29 (76.3) | 39 (25.3) | <0.001 |
| Fluconazole | 20 (10.4) | § | § | 0.081 |
| Amphotericin B | § | § | § | 0.016 |
| Underlying conditions and complications | ||||
| Sepsis | 123 (64.1) | 25 (65.8) | 98 (63.6) | 0.804 |
| Diabetes | 106 (55.2) | 20 (52.6) | 86 (55.8) | 0.721 |
| Chronic kidney disease | 85 (44.3) | 17 (44.7) | 68 (44.2) | 0.949 |
| Pneumonia | 83 (43.2) | 17 (44.7) | 66 (42.9) | 0.834 |
| Chronic respiratory failure | 61 (31.8) | 15 (39.5) | 46 (29.9) | 0.255 |
| Liver disease | 29 (15.1) | § | § | 0.099 |
| COVID-19 | 24 (12.5) | § | § | 0.891 |
| Solid organ malignancy | 21 (10.9) | § | § | 0.502 |
| Hematologic malignancy | § | § | § | 1.000 |
| HIV | § | § | § | 0.486 |
| Neutropenia | § | § | § | 1.000 |
| Transplant and complications | § | § | § | 0.585 |
| Medical devices | ||||
| Central venous catheter | 111 (57.8) | 29 (76.3) | 82 (53.2) | 0.010 |
| Mechanical ventilation | 83 (43.2) | 18 (47.4) | 65 (42.2) | 0.565 |
| Tracheostomy | 29 (15.1) | 11 (28.9) | 18 (11.7) | 0.008 |
| Feeding tube | 16 (8.3) | § | § | 0.913 |
| Urinary catheter | 17 (8.9) | § | § | 0.297 |
| Total parenteral nutrition |
17 (8.9) |
§ |
10 (6.5) |
0.021 |
| Outcomes | ||||
| Mean, median length of hospitalization, d (range) | 18.6, 13 (1–209) | 22.5, 16.5 (1–65) | 17.6, 12.0 (1–209) | 0.212 |
| Intensive care unit stay | 145 (75.5) | 30 (78.9) | 115 (74.7) | 0.583 |
| Discharge status | 0.046 | |||
| In-hospital death or discharged to hospice# | 65 (33.9) | 18 (47.4) | 47 (30.5) | 0.123 |
| Discharged to skilled nursing facility | 53 (27.6) | § | § | |
| Discharged to long-term care acute hospital | 28 (14.6) | § | § | |
| Other | 46 (24.0) | § | § | |
*Values are no. (%) patients except as indicated. Data were from the PINC-A1 Healthcare Database (PHD) (https://offers.premierinc.com/rs/381-NBB-525/images/PINC_AI_Healthcare_Data_White_Paper.pdf). Most C. auris hospitalizations were in the South (76.6%) or the Midwest (21.4%) regions; <10 C. auris hospitalizations were in the Northeast or the West regions; >95% of hospitals were in urban locations. A total of 35.4% of C. auris hospitalizations were from 2022, 51.0% were from 2021, and 13.5% were from 2017–2020. We found 0 C. auris hospitalizations for 2012–2016. †A total of 22 (57.9%) patients also had C. auris isolated from another specimen type; among those, 81.8% had both specimens collected on the same day, and the remainder had the bloodstream specimen collected first. ‡Specimen types: 59 axilla, 53 urine, 18 wound, 13 respiratory, 21 other or unspecified. §Nonzero number <10 or cell that would enable calculation of another cell <10. ¶Includes 112 (60.2%) non-Hispanic White and 21 (11.3%) Hispanic. #Forty (20.8%) in-hospital deaths and 25 (13.0%) discharged to hospice.