A Comprehensive Review of Epidemiology, Risk Factors, Clinical Manifestations, Antifungal Susceptibility, and Mortality of Candida auris in Saudi Arabia.

Candidemia, a common hospital-acquired bloodstream infection, is associated with significant mortality, particularly in cases involving (). The Middle East, including Saudi Arabia, has seen an increasing number of invasive infections. This review examines the epidemiology, risk factors, antifungal susceptibility, clinical manifestations, and mortality associated with , based on published literature from Saudi Arabia. In June 2024, a literature search was conducted using PubMed, Web of Science, and Google Scholar to identify studies on in Saudi Arabia. Relevant studies were selected based on title and full-text evaluations. Inclusion criteria focused on primary research conducted in Saudi Arabia that addressed the prevalence of , risk factors, colonization, infections, and mortality. A pooled analysis was performed to assess the prevalence, risk factors, and antifungal susceptibility. The mortality analysis included only studies that explicitly reported mortality as an outcome. Antifungal susceptibility analysis included all isolates from primary research, based on the United States Centers for Disease Control and Prevention (CDC) minimum inhibitory concentration (MIC) cut-offs or explicit reports of susceptibility. A total of 12 observational studies comprising 315 patients were analyzed. The mean age was 63 years, with a weighted mean of 37.54; 66% (8/12) of studies reported a mean age over 60 years. infection and colonization demonstrated a notable gender disparity. The most common risk factors included intensive care unit (ICU) stay, recent antimicrobial use, presence of central venous catheters, and mechanical ventilation. In infected individuals, the bloodstream was the most frequent site, followed by urine. Crude mortality was 46.8% (118/252), with 80.5% (95/118) of deaths occurring within 30 days. This review highlights a high prevalence of among older patients, with a significant male predominance in Saudi Arabia. Candidemia was the most frequent clinical presentation. Echinocandins continue to show the highest susceptibility, making them the most appropriate empirical antifungal agents when fungemia is suspected.