Risk factors associated with progression to clinical Candida auris infection among adults with previous colonization-Florida, 2019-2023.

Abstract

Candida auris (C. auris) is an emerging fungal organism that has caused outbreaks in healthcare settings and become a major public health concern, particularly among medically vulnerable populations. Using a retrospective case-control design, we investigated factors associated with C. auris clinical cases after prior colonization among patients identified in Florida healthcare facilities during January 1, 2019-December 31, 2023. We identified 105 case-patients with documented clinical specimens after colonization and 578 control subjects with colonization only. Factors significantly associated with clinical cases included presence of ≥ 5 comorbid conditions (OR, 10.02; 95% CI, 4.07-24.7), ≥ 4 invasive devices (OR, 2.92; 95% CI, 1.70-5.03), or ≥ 3 recent medical procedures (OR, 2.32; 95% CI, 1.19-4.55). Also, fully dependent care required for eating (OR 2.80), mobility (OR 2.15), and transferring (OR 1.82) were associated with clinical case progression. We found a significant association with progression from screening colonization to clinical C. auris cases among patients with multiple comorbidities, invasive devices, recent invasive procedures, and poor functional status. Identifying risk factors for clinical progression of C. auris after colonization could enable facilities to implement efficient testing protocols and infection prevention and control (IPC) measures to help prevent morbidity associated with invasive infections.