What is the treatment for Candida auris infection in urine?

From the Guidelines

The treatment for Candida auris infection in urine typically involves antifungal medications, with echinocandins being the first-line therapy, as recommended by the most recent guidelines 1. The choice of antifungal medication is crucial in treating Candida auris infections, given its multidrug resistance patterns.

• Echinocandins, such as micafungin, caspofungin, or anidulafungin, are recommended as the first-line therapy for Candida auris infections, including those affecting the urinary tract 1.
• The susceptibility of C. auris to echinocandins is high, with rates of 90% for caspofungin, 98.2% for micafungin, and 97.2% for anidulafungin 1.
• Treatment duration is generally 14 days, though this may be extended based on clinical response, and fluconazole may be used as step-down therapy only if the isolate demonstrates susceptibility 1.
• Removal of urinary catheters is crucial when present, as these devices serve as reservoirs for infection.
• Amphotericin B formulations may be considered in severe cases or when echinocandins are ineffective, though they carry greater toxicity risks, as noted in the management of COVID-19 associated fungal infections 1.
• Close monitoring of renal function is necessary during treatment, especially with amphotericin B formulations, to minimize the risk of nephrotoxicity.
• Antifungal susceptibility testing should guide treatment whenever possible, as resistance patterns vary geographically, highlighting the importance of tailored therapy for optimal outcomes 1.

From the Research

Treatment for Candida auris Infection in Urine

• The treatment for Candida auris infection in urine typically involves the use of antifungal medications, with echinocandin and liposomal amphotericin B recommended as first-line agents for most patients 2.
• Combination therapies, flucytosine, and amphotericin B bladder irrigations may be considered as alternative treatments in cases of infection persistence or recurrence 2.
• It is essential to note that C. auris is often resistant to one or more classes of antifungal medications, making treatment challenging 3, 4, 5.
• In some cases, combination therapy with antifungals and repurposed drugs, such as sertraline, may be effective against C. auris 6.
• The treatment approach should focus on aggressive treatment of C. auris to prevent subsequent invasive spread, multi-drug resistance, and ultimate mortality 2.

Antifungal Resistance and Treatment

• C. auris is characterized by its extensive innate and acquired resistance to antifungal drugs, including azoles, echinocandins, and polyenes 3, 4, 5.
• The emergence of pan-resistance to antifungal medications is a concern, and surveillance for C. auris, prudent antifungal prescribing, and susceptibility testing are crucial 5.
• The use of combination therapies and novel antifungals, such as ibrexafungerp or fosmanogepix, may be necessary for echinocandin-resistant strains 3.