From the Guidelines
Treatment for Candida auris typically involves antifungal medications, with echinocandins being the first-line therapy, as recommended by the most recent guidelines 1. The recommended echinocandins include micafungin, caspofungin, and anidulafungin, with susceptibility rates of 90%, 98.2%, and 97.2%, respectively 1.
- The treatment duration depends on the infection site and clinical response, usually lasting at least 14 days after the last positive culture.
- For resistant strains, combination therapy may be necessary, potentially adding amphotericin B or high-dose fluconazole if susceptibility testing permits 1.
- Removal of infected devices like catheters or implants is crucial for successful treatment.
- Strict infection control measures must be implemented simultaneously, including patient isolation, dedicated equipment, and thorough environmental cleaning with sporicidal agents, as C. auris is highly transmissible and can persist on surfaces for weeks 1. The overall susceptibility rate of C. auris to fluconazole was 10.7% and amphotericin B 43.1%, in 75 clinical isolates from patients with COVID-19, highlighting the need for susceptibility testing to guide therapy 1.
- The high mortality rate associated with C. auris infections, up to 64%, emphasizes the importance of prompt and effective treatment 1. The panel recommends echinocandins as the first-line therapy for candidemia caused by C. auris, with liposomal amphotericin B or amphotericin B deoxycholate considered for persistent candidemia or clinically unresponsive cases 1.
From the FDA Drug Label
14 CLINICAL STUDIES 14. 1 Treatment of Candidemia and Other Candida Infections in Adult and Pediatric Patients 4 Months of Age and Older
Two dose levels of micafungin for injection were evaluated in a randomized, double-blind study to determine the efficacy and safety versus caspofungin in patients with invasive candidiasis and candidemia
The FDA drug label does not answer the question.
From the Research
Treatment Options for Candida Auris
- Echinocandin and liposomal amphotericin B are recommended as first-line agents for most patients with C. auris isolated in the urine, as stated in the study 2.
- Combination therapies, flucytosine, and amphotericin B bladder irrigations are offered as potential alternatives in the event of infection persistence or recurrence, according to 2.
- Triazoles, echinocandins, and liposomal amphotericin B appear to have less activity against C. auris biofilms than deoxycholate amphotericin B, as shown in the study 3.
- Novel antifungal agents, such as ibrexafungerp and fosmanogepix, could provide a valid option against C. auris strains resistant to one or more older antifungals, including pan-resistant strains, as mentioned in 4.
- Rezafungin could allow once weekly administration of an active drug in the case of echinocandin-susceptible isolates, providing an effective outpatient treatment, as stated in 4.
Antifungal Resistance and Transmission
- C. auris exhibits greater antifungal resistance than other Candida species, posing major obstacles for the prevention and treatment of C. auris infection, as reported in 5.
- C. auris can persist on skin or in the surrounding environment for extended periods of time, leading to widespread outbreaks in healthcare facilities via patient-to-patient transmission, according to 5.
- Rapid and effective measures to contain C. auris spread require a multi-disciplinary approach, including clinical specialists, nursing staff, hospital hygiene, diagnostic microbiology, cleaning staff, hospital management, and experts in diagnostic mycology / fungal infections, as recommended in 6.
Management and Prevention
- Expert recommendations for prevention and management of Candida auris transmission include a step-wise process with relevant interventions differing between management of singular C. auris colonised / infected patients and detection of potential C. auris transmission or nosocomial outbreaks, as stated in 6.
- Identification of frequently colonized skin sites, risk factors for developing invasive infection, and patterns of antifungal resistance among C. auris strains can help guide therapeutic options, according to 5.