What is the treatment for Candida auris infection?

Treatment of Candida auris Infections

Echinocandins (caspofungin, micafungin, anidulafungin) are strongly recommended as first-line therapy for Candida auris infections due to their high susceptibility rates of 90-98.2%. 1

First-Line Treatment Options

• Echinocandins should be administered as the primary treatment for all C. auris infections, regardless of infection site 1
• Treatment should continue for at least 14 days after documented clearance of Candida from the bloodstream and resolution of symptoms 1
• Daily blood cultures should be obtained until clearance is documented to guide therapy duration 1

Alternative Treatment Options

• For persistent infection or clinical unresponsiveness to echinocandins, liposomal amphotericin B may be considered if susceptibility testing confirms no resistance 1
• Amphotericin B has limited reliability with only approximately 43.1% susceptibility against C. auris 1
• Fluconazole should be avoided due to extensive resistance (only 10.7% susceptibility) 1

Management of Specific Clinical Scenarios

• For bloodstream infections: Remove central venous catheters if present, as this is critical for resolving persistent candidemia 2
• For urinary tract infections with fungus balls or casts: Surgical intervention may be required in addition to antifungal therapy 1
• For neutropenic patients: Continue therapy until resolution of neutropenia 2

Monitoring and Follow-up

• Perform susceptibility testing on all C. auris isolates to confirm resistance patterns and guide therapy adjustments 1
• Conduct diagnostic workup to identify potential metastatic foci of infection if blood cultures remain positive 1
• Perform dilated funduscopic examination to rule out endophthalmitis and imaging of relevant organs if blood cultures remain positive 2

Infection Control Measures

• Implement strict isolation precautions for all C. auris cases 1
• Screen high-risk patients and close contacts using composite swabs of axilla and groin with specialized media 1
• Use sporicidal disinfectants (hydrogen peroxide, peracetic acid-based, or chlorine-based) for environmental cleaning 1
• Patients should be considered negative only after 3 consecutive negative screens taken at least 24 hours apart 1

Special Considerations

• C. auris is classified as an urgent public health threat due to its multidrug resistance and high mortality (up to 64%) 1
• C. auris can persist in the healthcare environment and colonize patients for extended periods, facilitating transmission 3
• Standard laboratory methods may misidentify C. auris as other Candida species, leading to inappropriate management 4
• MALDI-TOF and molecular methods such as PCR of ITS and D1/D2 regions are the most reliable identification techniques 5

Clinical Challenges

• C. auris has spread globally since its first identification in 2009, with cases reported in over 20 countries 6
• Immunocompromised patients, those with diabetes, recent antibiotic use, catheter use, and prolonged hospital stays are at highest risk 4
• The clinical presentation of C. auris is often non-specific and similar to other systemic infections 3
• Report all cases to state and local health departments and CDC to help track and control spread 7