Clinical characteristics and outcomes of Candida auris in a tertiary intensive care unit: a four-year retrospective case series.

backgroundCandida auris is an emerging multidrug-resistant yeast associated with healthcare-associated transmission and severe outcomes in intensive care settings. Clinical ICU-based cohort data from Türkiye remain limited.

methodsWe conducted a single-center retrospective case series in a tertiary adult intensive care unit in Türkiye, including patients with C. auris isolated from blood and/or urine cultures between January 1, 2021, and January 1, 2025. Species identification was performed by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). Antifungal susceptibility testing (AST) for selected isolates was conducted using the Sensititre™ YeastOne™ colorimetric microdilution system. Continuous variables were presented as mean ± standard deviation or median (minimum-maximum) according to distribution, whereas categorical variables were presented as frequencies and percentages. Comparative statistical analyses were not performed because of the descriptive case-series design and limited sample size.

resultsAmong 5,778 ICU patients evaluated during the study period, C. auris was identified in 36 patients. No cases were detected in 2021-2022; all cases occurred between September 18, 2023, and December 23, 2024, representing 2.37% of 1,517 ICU admissions during that interval. Isolation was most frequent in urine cultures (77.8%), followed by blood cultures (33.3%), with simultaneous urine and blood positivity in 11.1% of patients. The mean length of hospitalization before the first C. auris-positive culture was 44.9 days. All patients had urinary and central venous catheters and had received broad-spectrum antibiotics before C. auris detection. In the preceding month, MDR bacterial bloodstream infections were identified in 16 patients. AST data were available for four blood culture isolates from three patients; fluconazole MIC values were > 256 µg/mL in all tested isolates, whereas micafungin showed the lowest arithmetic mean MIC value (0.188 µg/mL).

conclusionsC. auris emerged in our ICU after 2023 and was mainly detected in patients with prolonged hospitalization, invasive devices, broad-spectrum antimicrobial exposure, and frequent MDR bacterial co-occurrence. These single-center data from Türkiye highlight the importance of reliable species-level identification, infection control awareness, and antimicrobial stewardship. Larger multicenter prospective studies using standardized surveillance and reference-method-based AST protocols are needed to better define transmission dynamics, resistance patterns, and clinical outcomes.