Epidemiological characteristics and antifungal susceptibility of Candida auris isolates in Candidemia cases at Akdeniz University Hospital

In this study, we aimed to identify Candida auris strains isolated from candidemia cases using the MALDI-TOF MS method, determine their antifungal susceptibility profiles, and evaluate the epidemiological characteristics of the affected patients. A total of 21 Candida auris isolates obtained from blood cultures of hospitalized patients in Akdeniz University Hospital between January 1, 2024, and June 31, 2025, were included in the study. Isolates were identified using the MALDI-TOF MS device (Zybio EXS 2600, EX-Smart Spect version 1.1.1.1005). Antifungal susceptibility testing was performed using the commercial colorimetric microdilution method, Thermo Scientific Sensititre YeastOne YO10 (SYO) (TREK Diagnostic Systems). Demographic and clinical data were collected from electronic records, including patients' age, gender, hospital ward, admission date, reason for hospitalization, underlying conditions, presence of neutropenia (<2000/mm³), history of abdominal surgery, use of immunosuppressive drugs and steroids, chemotherapy, central venous catheter use, total parenteral nutrition (TPN), presence of urinary catheter, administered antibiotics and antifungals, time to candidemia onset after hospitalization, candidemia treatment, agents used and duration, clinical outcomes, and antifungal MIC values of the isolates. Of the 21 patients from whom isolates were obtained, 14 (%66,7) were male and 7 (%33,3) were female, with a mean age of 60.3 ± 18.2 years. In our study, %66,7 (n=14) of the patients were admitted to intensive care units, while %33,3 (n=7) were hospitalized in other departments (Hematology, General Surgery, Neurosurgery, Thoracic Surgery, Cardiology). The highest case rate was observed in the Anesthesiology intensive care unit (%33,3). In terms of risk factors, all patients had urinary catheterization and a history of antibiotic use prior to the isolation of Candida auris. Mechanical ventilation was present in %85,7 of cases, central venous catheter use in 81 and intensive care unit admission in %66,7. The most common comorbidities were heart failure (%33,3), malignancy (%28,6), and hypertension (%28,6). Carbapenems (%95,2) and polymyxins (%52,4) were the most frequently used antibiotics before isolation, and %42,9 of patients had received antifungal therapy prior to isolation. The overall mortality rate was %66,7. According to CDC criteria, all isolates were resistant to fluconazole. Resistance to anidulafungin and micafungin was observed in %4,8 (n=1) of isolates, and resistance to caspofungin in %9,5 (n=2). No resistance to amphotericin B was detected. Based on EUCAST recommendations, all isolates were classified as susceptible, increased exposure (I), to amphotericin B, while resistance to micafungin and anidulafungin was identified in %9,5 (n=2) of isolates. Candida auris is an emerging fungal pathogen of concern due to its multidrug resistance, environmental persistence, and association with healthcare-associated infections. Awareness of local patient characteristics and resistance patterns is essential for optimizing empirical therapy and reducing mortality.