Treatment and Management of C. auris Infections and Colonization
Recommendations for treatment of Candida auris infections
Consultation with an infectious disease specialist is highly recommended when caring for patients with C. auris infection.
Even after treatment for invasive infections, patients generally remain colonized with C. auris for long periods, and perhaps indefinitely. Therefore, all recommended infection control measures should be followed during and after treatment for C. auris infection.
Adults and children ≥ 2 months of age
Based on the limited data available to date, an echinocandin drug at a dose listed below is recommended initial therapy for treatment of C. auris infections.
Dose information for Adults and Children ≥ 2 months of age
| Echinocandin Drug | Adult dosing | Pediatric dosing |
|---|---|---|
| Anidulafungin | loading dose 200 mg IV, then 100 mg IV daily |
not approved for use in children |
| Caspofungin | loading dose 70 mg IV, then 50 mg IV daily |
loading dose 70mg/m2/day IV, then 50mg/m2/day IV (based on body surface area) |
| Micafungin | 100 mg IV daily | 2mg/kg/day IV with option to increase to 4mg/kg/day IV in children at least 40 kg |
Most strains of C. auris found in the United States have been susceptible to echinocandins although reports of echinocandin—or pan-resistant cases are increasing. This organism appears to develop resistance quickly. Patients on antifungal treatment should be carefully monitored for clinical improvement. Follow-up cultures and repeat susceptibility testing should be conducted. Both recurrent and persistent C. auris bloodstream infections have been documented.
Switching to a liposomal amphotericin B (5 mg/kg daily) could be considered if the patient is clinically unresponsive to echinocandin treatment or has persistent fungemia for >5 days.
Data are lacking about the most appropriate therapy for pan-resistant strains. Combination antifungal treatment yielded promising results in laboratory testing but has not been evaluated in clinical settings. Investigational drugs have been tried against C. auris and may be considered for patients with echinocandin-resistant isolates. Contact these companies to learn more about accessing the drugs through their expanded access programs:
Fosmanogepix: FMGXExpandedAccess@pfizer.com
Ibrexafungerp: expandedaccess@scynexis.com
All other considerations for management of C. auris infections are similar to the management of invasive infections with other Candida species. Details are available in the 2016 IDSA Clinical Practice Guideline for the Management of Candidiasis.
Neonates and infants <2 months of age
The initial treatment of choice for this age group is amphotericin B deoxycholate, 1 mg/kg daily. If unresponsive to amphotericin B deoxycholate, liposomal amphotericin B, 5mg/kg daily, could be considered. In exceptional circumstances, where central nervous system involvement has been definitively ruled out, may consider use of echinocandins with caution at the following doses:
Dose information for neonates and infants <2 months of age
| Echinocandin Drug | Neonatal dosing |
|---|---|
| Caspofungin | 25 mg/m2/day IV (based on body surface area) |
| Micafungin | 10mg/kg/day IV |
All other considerations for management of C. auris are similar to other Candida species infections. Details are available in the 2016 IDSA Clinical Practice Guideline for the Management of Candidiasis.
Management of C. auris isolated from noninvasive, nonsterile body sites (e.g., urine, external ear, wounds, respiratory specimens, and skin colonization)
Treatment
CDC does not recommend treatment of C. auris identified from noninvasive sites (such as respiratory tract, urine, and skin colonization) when there is no evidence of infection. Similar to recommendations for other Candida species, treatment is generally only indicated if clinical disease is present. However, infection control measures should be used for all patients with C. auris, regardless of source of specimen.
Prevention of invasive infections
Patients who become colonized with C. auris are at risk of developing invasive infections from this organism. Invasive infections can develop at any point after patients become colonized. Additional measures listed below can help prevent invasive C. auris infection once patients become colonized with C. auris.
Appropriate care of medical devices
Many patients with C. auris colonization already have or may need various types of invasive lines and tubes, including central venous catheters, urinary catheters, and tracheostomy tubes. These devices can serve as portals of entry for the organism into invasive body sites.
Appropriate care of medical devices is needed to prevent infections. This care includes strict adherence to recommended central venous catheter and urinary catheter insertion and maintenance practices and meticulous care of tracheostomy sites. Clinicians should continually assess the need for invasive devices and promptly remove them when they are no longer needed. When a healthcare facility determines that a patient has C. auris infection or colonization, the staff should review protocols for care of medical devices and evaluate current adherence to protocols. More information on appropriate care of medical devices is available in the Infection Control Guidelines Library.
Surgical procedures
Patients colonized with C. auris and undergoing surgical procedures may also be at increased risk for surgical site infections. Meticulous skin preparation in the operating room should be performed using an alcohol-based agent unless contraindicated. Further guidance on preventing surgical site infections is available in the CDC Guideline for the Prevention of Surgical Site Infection.
Antibiotic stewardship
Many patients with C. auris infection or colonization have received broad-spectrum antibacterial and antifungal medications in the weeks before their first culture yielding C. auris. Assessing the appropriateness of antibiotics, especially antifungals, and discontinuing them when not needed may help prevent C. auris colonization and infection.