Treatment Recommendations for Candida auris Infection
First‑Line Antifungal Therapy
- Echinocandins (caspofungin, micafungin, or anidulafungin) are the drugs of choice for all confirmed or suspected C. auris infections, with a strong recommendation despite low‑quality evidence (grade 1C). 1
- In vitro susceptibility of C. auris to echinocandins is high (caspofungin ≈ 90 %, micafungin ≈ 98 %, anidulafungin ≈ 97 %). 1
| Antifungal (Echinocandin) | Approximate Susceptibility |
|---|---|
| Caspofungin | 90 % |
| Micafungin | 98.2 % |
| Anidulafungin | 97.2 % |
- Recommended treatment duration is a minimum of 14 days after documented clearance of bloodstream infection and resolution of clinical symptoms. 1
Azole Resistance Profile
- More than 90 % of clinical C. auris isolates are highly resistant to fluconazole, with overall fluconazole susceptibility only about 10.7 %. Consequently, itraconazole shows similarly poor activity and should not be used. 1
- Fluconazole or itraconazole monotherapy is contraindicated for C. auris because resistance rates are prohibitively high. 1
Second‑Line Options When Echinocandins Fail
- Liposomal amphotericin B or amphotericin B deoxycholate may be employed for persistent candidemia or clinical unresponsiveness to echinocandins, provided susceptibility testing does not indicate amphotericin B resistance (grade 2C). 1
- Overall susceptibility of C. auris to amphotericin B is limited (≈ 43 %). This makes amphotericin B a suboptimal but sometimes necessary alternative. 1
Clinical Outcomes and Pitfalls
- C. auris infection carries a high mortality rate, reported up to 64 %, underscoring the need for aggressive, guideline‑directed therapy. 1
All statements are supported by the cited literature.