Management of Candida auris Bacteremia

Initial Antifungal Therapy

• The Infectious Diseases Society of America recommends starting an echinocandin as first-line treatment for Candida auris bacteremia, with dosing options including Caspofungin: 70 mg loading dose, then 50 mg daily, Micafungin: 100 mg daily, and Anidulafungin: 200 mg loading dose, then 100 mg daily 1, 2, 3
• Lipid formulation amphotericin B (3-5 mg/kg daily) serves as an alternative option, though 35% of isolates show amphotericin B resistance 4

Critical Diagnostic and Monitoring Steps

• Obtain antifungal susceptibility testing immediately on all C. auris isolates, testing for both azole and echinocandin susceptibility, as 7% of isolates are echinocandin-resistant and 41% are resistant to two antifungal classes 1
• Perform follow-up blood cultures daily or every other day to document clearance of the organism 4, 2
• Conduct a dilated ophthalmological examination within the first week after diagnosis to rule out endophthalmitis 4, 2

Source Control Measures

• 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 4

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 4, 2
• Do not discontinue therapy prematurely before documented clearance, as this can lead to relapse 3