From the Guidelines
The CDC is tracking drug-resistant fungi, particularly Candida auris, which poses a serious global health threat due to its extensive resistance to antifungal agents and high mortality, as reported in a recent study published in 2023 1. According to the most recent evidence, C. auris is resistant to multiple antifungal medications, including fluconazole, with an overall susceptibility rate of 10.7%, and amphotericin B, with a susceptibility rate of 43.1% 1. The treatment of C. auris infections typically involves high-dose echinocandins, such as caspofungin, micafungin, or anidulafungin, often administered intravenously for 14-21 days depending on infection severity, as suggested by previous guidelines 1. Some key points to consider in the treatment and prevention of C. auris infections include:
- The fungus spreads easily in healthcare settings, particularly among patients with weakened immune systems, diabetes, recent surgery, or those with invasive medical devices.
- Prevention focuses on proper hand hygiene, contact precautions, thorough environmental cleaning with hospital-grade disinfectants effective against C. difficile, and screening high-risk patients.
- Drug resistance develops because fungi can evolve mechanisms to pump antifungals out of their cells, modify drug targets, or form protective biofilms, making infections increasingly difficult to treat and highlighting the need for antimicrobial stewardship. It is essential to prioritize the most recent and highest-quality evidence when making treatment decisions, and in this case, the 2023 study provides the most up-to-date information on the diagnosis and management of C. auris infections 1.
From the Research
Drug-Resistant Fungi
According to the Centers for Disease Control and Prevention (CDC), Candida auris is a multidrug-resistant fungal pathogen that poses serious threats to public health 2, 3, 4, 5, 6.
Characteristics of Candida auris
- Candida auris is associated with nosocomial infections that cause invasive candidiasis in immunocompromised patients 2
- It is highly resistant to azole drugs, especially fluconazole, with some strains resistant to all three classes of commonly used antifungals 2, 5
- The high rates of intrinsic and acquired drug resistance make treatment extremely problematic 2
- Candida auris can be misidentified as other yeasts by commonly available identification methods, making control challenging 6
Antifungal Drug Susceptibility Pattern
- Fluconazole resistance is common in Candida auris, with 84% of isolates found to be resistant in one study 5
- Posaconazole, itraconazole, and amphotericin B exhibit potent activity against Candida auris 5
- Echinocandins, such as caspofungin, micafungin, and anidulafungin, also show activity against Candida auris 5
- Pan azole-resistant and pan drug-resistant strains of Candida auris are emerging 5
Treatment Options
- Rezafungin was approved by the US Food and Drug Administration (FDA) for the treatment of candidemia and invasive candidiasis 4
- Ibrexafungerp and fosmanogepix have entered phase III clinical trials for the treatment of Candida auris infections 4
- Combination therapy with amphotericin B and echinocandins has shown synergistic effects against Candida auris 3