The study describes the development and validation of the AURIS score, a clinical prediction tool designed to estimate the risk of candidemia among intensive care unit (ICU) patients colonised with Candidozyma auris. This multidrug-resistant fungal pathogen has emerged globally as a major health-care threat, characterised by prolonged colonisation, frequent hospital outbreaks, high antifungal resistance, and mortality rates of 40–60% in invasive infections. Although several risk scores for invasive candidiasis exist, none were developed specifically for Candidozyma auris or validated in colonised patients during outbreaks.
This bicentric retrospective cohort study analysed prospectively collected data from two tertiary hospitals in Valencia, Spain, during prolonged Candidozyma auris outbreaks (2017–2020). Adult ICU patients with documented Candidozyma auris colonisation were included and followed for the development of candidemia. The investigators first externally validated a previously derived single-centre prediction model and then refined it in a pooled bicentric cohort.
The external validation cohort included colonised ICU patients, a portion of whom developed candidemia. After pooling with the original derivation cohort, the final dataset comprised patients with candidemia events. Model refinement identified four independent predictors of candidemia: total parenteral nutrition (TPN), previous antifungal therapy, multifocal colonisation, and urinary isolation of Candidozyma auris. These variables were incorporated into a simplified four-variable model named the AURIS score.
The authors conclude that the AURIS score provides a pragmatic and clinically usable tool for risk stratification in Candidozyma auris-colonised ICU patients. Its high negative predictive value makes it particularly valuable for identifying low-risk individuals, potentially reducing unnecessary empirical antifungal therapy and supporting antifungal stewardship. However, broader validation across diverse epidemiological settings and Candidozyma auris clades is required before widespread implementation.
Reference
Garcia-Bustos V, Puchades F, Alonso-Ecenarro F, et al. Development and validation of the AURIS score for predicting candidaemia in Candidozyma auris-colonised patients in the intensive care unit: a bicentric retrospective cohort study. Lancet Infect Dis. 2026:S1473-3099(26)00002-2. doi: 10.1016/S1473-3099(26)00002-2. Epub ahead of print.
