Clinical Characteristics and Mortality Risk Factors of Candida lusitaniae Candidemia: A Multicenter Study in Korea

초록

Background: Candida lusitaniae, currently taxonomically classified as Clavispora lusitaniae, is a candidemia due to non-albicans Candida species, featuring unusual antifungal susceptibility profile and rapid resistance acquisition. This multicenter cohort study aimed to identify mortality risk factors in Korean patients with C. lusitaniae candidemia. Methods: We retrospectively analyzed 53 C. lusitaniae candidemia cases from six university hospitals in Korea between January 2019 and December 2024. Demographic and clinical characteristics were compared between survivors and patients who died during their hospital stay (non-survivors). Univariate and multivariate Cox regression analyses were conducted to determine independent risk factors for 30-and 60-day mortality. Results: During the study period, C. lusitaniae was the fifth most common cause of candidemia. The overall in-hospital mortality was 69.8%, with 30-and 60-day mortality rates of 39.6% and 47.2%, respectively. The non-survivor group comprised a significantly higher proportion of patients with lymphoma and those receiving immunosuppressive therapy. Independent risk factors for 30-day mortality included severe sepsis (hazard ratio 9.02), intensive care unit (ICU) admission (3.32), total parenteral nutrition use (7.60), moderate-to-severe kidney disease (3.34), fluconazole non-wild type (WT) isolates (105.06), and amphotericin B non-WT or multidrug-resistant (MDR) isolates (11.83). For 60-day mortality, independent risk factors were severe sepsis (3.66), ICU admission (3.44), moderate-to-severe kidney disease (2.72), fluconazole non-WT isolates (91.23), and amphotericin B non-WT or MDR isolates (8.63). Conclusions: MDR or non-WT isolates, along with host factors such as severe sepsis, are associated with a worse prognosis in C. lusitaniae candidemia in Korea. These findings highlight the need for careful monitoring and management of high-risk patients.

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