Treatment of Candida auris in Urine

Treatment Algorithm Based on Clinical Presentation

• The Infectious Diseases Society of America recommends caspofungin (70-mg loading dose, then 50 mg daily), micafungin (100 mg daily), or anidulafungin (200-mg loading dose, then 100 mg daily) as first-line therapy for suspected C. auris cystitis 1, 2
• For persistent infection, consider amphotericin B deoxycholate bladder irrigation (50 mg/L sterile water daily for 5 days) as adjunctive therapy 1, 3

Management of Urinary Catheters and Obstruction

• Removal or replacement of indwelling urinary catheters may resolve candiduria in up to 50% of cases, and is recommended when possible 3
• Elimination of urinary tract obstruction is strongly recommended as a critical part of treatment 1, 3

Monitoring and Follow-up

• Monitor for clinical improvement and obtain follow-up urine cultures to confirm clearance of infection 5
• For persistent infection despite appropriate therapy, consider imaging to rule out anatomical abnormalities or fungus balls 3, 6

Common Pitfalls to Avoid

• Do not use lipid formulations of amphotericin B for isolated lower UTI, as they do not achieve adequate urine concentrations 3, 6
• Avoid treating asymptomatic candiduria in patients without risk factors for dissemination 4, 5