The Ramifications of Candida auris Colonization and Infection in Intensive Care Units: Epidemiology, Risk Factors, Associated Carbapenem-Resistant Enterobacteriaceae, and Future Outlooks: Cross-Sectional Study.

Abstract

Background: Candida auris (C. auris) has emerged as one of the most formidable healthcare-associated fungal pathogens, particularly within intensive care units (ICUs) where prolonged antimicrobial exposure, invasive procedures, and critical illness converge. its persistence in hospital environments and resistance pattern to several antifungal classes make it a serious infection-control concern globally and a growing threat to patient safety in high-acuity hospital settings. Objectives: This study investigated the epidemiological, clinical, and microbiological profiles of intensive care unit (ICU) patients with laboratory-confirmed C. auris infection and assessed its association with carbapenem-resistant Enterobacterales (CRE) co-infection and relevant clinical risk factors. Methods: A cross-sectional observational study was conducted among forty intensive care unit (ICU) patients admitted to Al-Azhar University Hospitals and affiliated private facilities between January and August 2025. All C. auris isolates were identified using CHROMagar culture and molecularly confirmed by real-time PCR. Data were analyzed using SPSS version 25 and Python for reproducibility. Descriptive and inferential statistics were applied, with categorical variables evaluated by Chi-square test and statistical significance defined at p < 0.05. Results: The mean age of the forty ICU patients was 67.0 ± 15.2 years, with an equal male-to-female ratio (1:1). C. auris infection demonstrated significant associations with bacterial pneumonia, cerebral haemorrhage, and septic shock (χ² = 6.24, p = 0.013). Co-isolation of carbapenem-resistant Klebsiella species (CRE) was detected in 65 % of cases (χ² = 5.61, p = 0.021). Age and sex were not significant predictors of infection risk (p > 0.05). Conclusion: C. auris infection in intensive care units (ICUs) predominantly affects elderly, critically ill patients and frequently coexists with carbapenem-resistant Klebsiella species (CRE). Its persistence and multidrug resistance necessitate routine PCR-based screening, integrated fungal-bacterial surveillance, and strict adherence to contact-precaution protocols. In addition, chlorine-based environmental disinfection and evidence-driven containment strategies are essential to prevent cross-transmission and to maintain infection-control resilience in high-risk healthcare environments.