Treatment of Candida auris Infection
Echinocandins are the first-line treatment for Candida auris infections, with specific dosing of caspofungin (70 mg loading dose, then 50 mg daily), micafungin (100 mg daily), or anidulafungin (200 mg loading dose, then 100 mg daily). 1, 2
Initial Antifungal Therapy
Start an echinocandin immediately as empiric therapy for suspected or confirmed C. auris bacteremia, as this species demonstrates extensive antifungal resistance with 93% of isolates resistant to fluconazole and 35% resistant to amphotericin B 1, 3
The three echinocandin options have equivalent efficacy, though 7% of C. auris isolates show echinocandin resistance and 41% are resistant to two antifungal classes 2, 3
Lipid formulation amphotericin B (3-5 mg/kg daily) serves as second-line therapy for persistent candidemia or clinical unresponsiveness to echinocandins, though 35% of isolates demonstrate amphotericin B resistance 1, 2, 3
Fluconazole should not be used for C. auris given the 10.7% overall susceptibility rate and 93% resistance in most isolates 1, 3
Critical Diagnostic and Management Steps
Obtain antifungal susceptibility testing immediately on all C. auris isolates, testing for both azole and echinocandin susceptibility, as resistance patterns vary significantly by geographic clade 2, 3
Remove central venous catheters as early as possible when the catheter is the presumed source and can be safely removed, as 73% of C. auris patients have central venous catheters and source control significantly impacts outcomes 2, 3
Perform follow-up blood cultures daily or every other day to document clearance of the organism, as premature discontinuation before documented clearance can lead to relapse 2
Conduct a dilated ophthalmological examination within the first week after diagnosis to rule out endophthalmitis 2
Treatment Duration
Continue antifungal therapy for a minimum of 14 days after documented clearance of Candida from the bloodstream and resolution of symptoms attributable to candidemia 1, 2
Do not discontinue therapy prematurely before documented clearance, as this increases relapse risk 2
Infection Control Considerations
C. auris is unique among Candida species due to its ability to colonize patients indefinitely and persist in the healthcare environment, requiring aggressive infection control measures to prevent nosocomial transmission 4, 5
The transmissibility and high levels of antifungal resistance distinguish C. auris from other Candida species, necessitating robust coordination between laboratory, clinicians, and public health agencies 4
Common Pitfalls to Avoid
Do not use fluconazole empirically for suspected C. auris, as 93% of isolates are resistant 1, 3
Do not rely on traditional biochemical identification methods, as C. auris can be misidentified as other yeasts; molecular or MALDI-TOF identification is required 4
Do not assume echinocandin susceptibility without testing, as 7% of isolates are echinocandin-resistant and resistance may develop during therapy 2, 5