Clinical Overview: Treatment Options for Candida Auris

Candida Auris, also known as C. Auris, is a type of yeast that can infect and cause severe illness in humans if spread. This yeast spreads easily from one person to another and is resistant to many treatment options, including antifungals, which makes its spread more problematic and its treatment much harder.¹

In 2022, there were approximately 2377 cases of C. Auris and about 5754 screening cases.2 With the organism’s potential to cause severe symptoms, severe disease, and possible death, it is essential to care for infected individuals and to treat those known to be infected.

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The symptoms of C. Auris infections may differ based on the infected organs in the body. It can cause ear infections as well as infections in the blood or wounds. Depending on the location of the infection, the symptoms can vary and can be produced at various times. Many individuals can get C. Auris yeast on their skin without developing an infection. Such colonization may not cause the person to get sick but can be spread to other individuals.¹

When it comes to C. Auris diagnosis, health care providers can screen patients by using swabs near the armpits and groin areas of the body. If the patient is showing symptoms, providers should also collect other samples such blood and urine. This is especially important for those that are more susceptible to major infection caused by C. Auris, including those with comorbidities, older individuals, or immunocompromised patients.¹

If diagnosed with C. Auris, patients should see a specialist or an infectious disease specialist. As mentioned above, C. Auris can be very resistant to the most common treatment options, including commonly used antifungal medications. Some individuals infected with C. Auris may need multiple antifungals as an aggressive treatment plan.¹

Some of the common antifungals used to treat C. Auris may include anidulafungin (Eraxis; Pfizer), with a loading dose of 200 mg intravenously then 100 mg daily. Notably, it is not approved at this time to be used in children. Another option is caspofungin (Cancidas; Merck), with a loading dose of 70 mg intravenously followed by 50 mg daily. Lastly, micafungin (Mycamine; Astellas Pharma) 100 mg intravenously daily can be used as another treatment option, with options of 2mg/kg/day and increasing to 4mg/kg/day in children weighing at least 40 kg.3 Clinicians should always consult with infectious disease specialists to verify the appropriate dosing.

Most strains of C. Auris in the United States are susceptible to echinocandin drugs. However, in recent years, resistance to these medications has increased. If patients prove unresponsive to echinocandin treatments, liposomal amphotericin B (AmBisome; Astellas Pharma) 5mg/kg daily could be considered.

Prevention of C. Auris infection can be just as important as treatments. Patients that become colonized by C. auris are at higher risk of developing invasive infections. For such individuals, especially those showing symptoms, consultation with an infection control specialist and adherence to recommended treatment options is very important. This is especially important if there is a known case of C. Auris in a clinic setting or a hospital. In such environments, strict protocols and adherence to screening steps and preventive steps is crucial to avoid spreading the organism to other individuals, including other patients or health care providers.

Such measures could include isolating the patient, isolating the room the patient is in, cleaning the room with special disinfectant products on regular basis, washing hands on regular basis, and wearing gloves, gowns, and appropriate protective clothing.

Individuals infected with C. Auris can often continue to have the organism on their skin and body for a very long period. Whether these patients remain symptomatic or not, they can easily spread the disease and the organism to others. This could be a major problem for facilities such as long-term care facilities. Careful screening of these patients, implementing immediate prevention tools, and monitoring patients on regular basis could be the difference between full containment or spread of the infection.

References

1. About Candida auris (C. auris). CDC. Reviewed October 4, 2023. Accessed November 8, 2023. https://www.cdc.gov/fungal/candida-auris/candida-auris-qanda.html#:~:text=Resistance%20and%20Treatment,-C.&text=auris%20is%20often%20resistant%20to,of%20antifungal%20medicines%20called%20echinocandins.

2. Tracking Candida auris. CDC. Reviewed February 14, 2023. Accessed November 8, 2023. https://www.cdc.gov/fungal/candida-auris/tracking-c-auris.html

3. Treatment and management of C. auris infections and colonization. CDC. Reviewed December 14, 2022. Accessed November 8, 2023. https://www.cdc.gov/fungal/candida-auris/c-auris-treatment.html