What is the treatment for Candida (C.) auris infections?

Treatment of Candida auris Infections

Echinocandins are the first-line treatment for Candida auris infections due to their high susceptibility rates and effectiveness against this multidrug-resistant pathogen. 1

First-Line Treatment Options

• Echinocandins (caspofungin, micafungin, anidulafungin) are strongly recommended as first-line therapy for C. auris infections, with susceptibility rates of 90-98.2% 1
• For non-critically ill patients with low risk of azole resistance and non-C. auris Candida infections, fluconazole may be considered, but this is NOT appropriate for C. auris due to its high fluconazole resistance (only 10.7% susceptibility) 1
• Treatment should continue for at least 14 days after documented clearance of Candida from the bloodstream and resolution of symptoms 1

Alternative Treatment Options

• For persistent candidemia or clinical unresponsiveness to echinocandins, liposomal amphotericin B or amphotericin B deoxycholate may be considered if susceptibility testing confirms no resistance 1
• The overall susceptibility rate of C. auris to amphotericin B is approximately 43.1%, making it a less reliable option than echinocandins 1
• Fluconazole should be avoided for C. auris infections due to extensive resistance (only 10.7% susceptibility) 1

Treatment Considerations by Infection Site

• For bloodstream infections (candidemia): Echinocandins are the first-line therapy 1
• For sites other than bloodstream: Follow standard antifungal treatment guidelines with preference for echinocandins when C. auris is identified 1
• For fungus balls or casts in the urinary tract: Surgical intervention may be required in addition to antifungal therapy 1

Infection Control Measures

• Implement strict infection control measures for all C. auris cases, including patient isolation 1, 2
• Screen high-risk patients and close contacts using composite swabs of axilla and groin with specialized salt-containing media or chromogenic agars 1, 2
• Use sporicidal disinfectants (hydrogen peroxide, peracetic acid-based, or chlorine-based) for environmental cleaning as quaternary ammonium compounds have poor activity against Candida species 1, 2
• Patients should be considered negative only after 3 consecutive negative screens taken at least 24 hours apart 1, 2

Monitoring and Follow-up

• Obtain daily blood cultures until clearance is documented 3
• Monitor for development of resistance, particularly with echinocandins, as resistance may develop during therapy 4, 5
• Perform susceptibility testing on isolates to confirm resistance patterns and guide therapy adjustments 3, 5
• Conduct diagnostic workup to identify potential metastatic foci of infection if blood cultures remain positive 3

Special Considerations

• C. auris is classified as an urgent public health threat due to its multidrug resistance, high mortality (up to 64%), and ability to spread in healthcare settings 1, 4
• Patients generally remain colonized for long periods even after treatment, necessitating continued infection control measures 4
• The emergence of echinocandin-resistant C. auris is concerning, with recent reports showing an increase in such cases 5
• Aggressive infection control measures are paramount to stopping transmission in healthcare facilities 4, 6