Treatment of Candida auris Infections

First-Line Treatment Options

Echinocandins (caspofungin, micafungin, anidulafungin) are strongly recommended as first-line therapy for C. auris infections, with susceptibility rates of 90-98.2% 1, 2, 3
For non-critically ill patients with low risk of azole resistance and non-C. auris Candida infections, fluconazole may be considered, but this is NOT appropriate for C. auris due to its high fluconazole resistance (only 10.7% susceptibility) 2, 3
Treatment should continue for at least 14 days after documented clearance of Candida from the bloodstream and resolution of symptoms 2, 3

For persistent candidemia or clinical unresponsiveness to echinocandins, liposomal amphotericin B or amphotericin B deoxycholate may be considered if susceptibility testing confirms no resistance 1, 2, 3
The overall susceptibility rate of C. auris to amphotericin B is approximately 43.1%, making it a less reliable option than echinocandins 1, 2
Fluconazole should be avoided for C. auris infections due to extensive resistance (only 10.7% susceptibility) 1, 2

For bloodstream infections (candidemia): Echinocandins are the first-line therapy 1, 2, 3
For sites other than bloodstream: Follow standard antifungal treatment guidelines with preference for echinocandins when C. auris is identified 2, 3
For fungus balls or casts in the urinary tract: Surgical intervention may be required in addition to antifungal therapy 2, 3

Implement strict infection control measures for all C. auris cases, including patient isolation 4, 5
Screen high-risk patients and close contacts using composite swabs of axilla and groin with specialized salt-containing media or chromogenic agars 4, 5
Use sporicidal disinfectants (hydrogen peroxide, peracetic acid-based, or chlorine-based) for environmental cleaning as quaternary ammonium compounds have poor activity against Candida species 4, 5
Patients should be considered negative only after 3 consecutive negative screens taken at least 24 hours apart 4, 5

Obtain daily blood cultures until clearance is documented 6
Perform susceptibility testing on isolates to confirm resistance patterns and guide therapy adjustments 6
Conduct diagnostic workup to identify potential metastatic foci of infection if blood cultures remain positive 6

C. auris is classified as an urgent public health threat due to its multidrug resistance, high mortality (up to 64%), and ability to spread in healthcare settings 7, 8