COVID-19 and C. auris : A Case-Control Study from a Tertiary Care Center in Lebanon.

Many healthcare centers around the world have reported the surge of Candida auris ( C. auris ) outbreaks during the COVID-19 pandemic, especially among intensive care unit (ICU) patients. This is a retrospective study conducted at the American University of Beirut Medical Center (AUBMC) between 1 October 2020 and 15 June 2021, to identify risk factors for acquiring C. auris in patients with severe COVID-19 infection and to evaluate the impact of C. auris on mortality in patients admitted to the ICU during that period. Twenty-four non-COVID-19 (COV-) patients were admitted to ICUs at AUBMC during that period and acquired C. auris ( C. auris +/COV-). Thirty-two patients admitted with severe COVID-19 (COV+) acquired C. auris ( C. auris +/COV+), and 130 patients had severe COVID-19 without C. auris ( C. auris- /COV+). Bivariable analysis between the groups of ( C. auris +/COV+) and ( C. auris- /COV+) showed that higher quick sequential organ failure assessment (qSOFA) score ( p < 0.001), prolonged length of stay (LOS) ( p = 0.02), and the presence of a urinary catheter ( p = 0.015) or of a central venous catheter (CVC) ( p = 0.01) were associated with positive culture for C. auris in patients with severe COVID-19. The multivariable analysis showed that prolonged LOS ( p = 0.008) and a high qSOFA score ( p < 0.001) were the only risk factors independently associated with positive culture for C. auris . Increased LOS ( p = 0.02), high "Candida score" ( p = 0.01), and septic shock ( p < 0.001) were associated with increased mortality within 30 days of positive culture for C. auris . Antifungal therapy for at least 7 days ( p = 0.03) appeared to decrease mortality within 30 days of positive culture for C. auris . Only septic shock was associated with increased mortality in patients with C. auris ( p = 0.006) in the multivariable analysis. C. auris is an emerging pathogen that constitutes a threat to the healthcare sector.