Abstract / Summary
Abstract Background Candida auris is an emerging multidrug-resistant yeast associated with healthcare-associated invasive infections, particularly among critically ill patients. Data describing C. auris bloodstream infection in Tanzania are limited. This study determined the prevalence, associated factors, and antifungal susceptibility patterns of C. auris bloodstream infection among adult patients in the general intensive care unit (ICU) of Benjamin Mkapa Hospital (BMH), Tanzania. Methods A hospital-based cross-sectional study was conducted from January to April 2026 among 186 adults admitted to the general ICU for more than 48 hours with clinical suspicion of bloodstream infection. Blood cultures were processed using the BACTEC automated system. Yeast isolates were identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Antifungal susceptibility testing was performed using the VITEK 2 Compact system with a yeast susceptibility card. Minimum inhibitory concentrations (MICs) were interpreted using Centers for Disease Control and Prevention (CDC) tentative C. auris breakpoints. Data were analysed in R version 4.4.0 using Fisher’s exact test and Firth-penalized logistic regression. Results C. auris was identified in 4 of 186 participants, giving a prevalence of 2.15%. All four isolates were resistant to fluconazole (MIC 32–64 mg/L). Amphotericin B showed variable activity, with two isolates susceptible (MIC 0.5–1 mg/L) and two resistant (MIC 2 mg/L). Three isolates were susceptible to caspofungin (MIC 0.25–0.50 mg/L), while one was resistant (MIC 2 mg/L). In multivariable analysis, ICU stay ≥ 7 days (adjusted odds ratio [AOR] 6.09, 95% confidence interval [CI] 1.12–21.30; p = 0.033) and immunosuppression (AOR 8.34, 95% CI 1.07–32.09; p = 0.043) were independently associated with C. auris infection. Conclusion C. auris bloodstream infection was detected among adult ICU patients at BMH at a prevalence of 2.15% and demonstrated substantial antifungal resistance, particularly to fluconazole. Prolonged ICU stay and immunosuppression were independently associated with infection. Strengthening fungal diagnostic capacity, antifungal susceptibility testing, infection prevention and control, surveillance, and antifungal stewardship is warranted in this setting.