Help manage Candida auris

For example, be suspicious in patients with Candida plus multidrug-resistant bacteria, especially carbapenem-resistant Enterobacterales....

As a critical care pharmacist, you should know how to manage the multidrug-resistant yeast and Candida auris. C. auris can be fatal in up to about 60% of patients. It spreads easily, contaminates surfaces and is tough to eliminate. Plus it’s difficult to identify C. auris. It can mistakenly be reported as another yeast, especially Candida haemulonii.

Know when to put C. auris on your radar, particularly if it’s reported in your area. For example, be suspicious in patients with Candida plus multidrug-resistant bacteria, especially carbapenem-resistant Enterobacterales. Also consider it with invasive Candida in those hospitalized outside your country in the past year, or from a nursing home that uses ventilators. Work with your ID specialists and contact your local health department for guidance if C. auris is suspected.

Generally, treat C. auris infections empirically with an echinocandin (micafungin 100 mg IV daily, etc). Think about switching to liposomal amphotericin B (5 mg/kg) if there’s persistent fungemia for over 5 days, or no clinical response. Avoid fluconazole, over 90% of C. auris is resistant. Emphasize hand hygiene and other prevention strategies. C. auris can live on surfaces for weeks, and on patients for months. If C. auris is identified, expect screening for colonization in certain other patients, such as roommates of the case patient from the past month. But don’t decolonize patients due to lack of data. Instead, anticipate that infected or colonized patients will be put in single rooms and placed on contact precautions. Recommend cleaning daily and after discharge with an agent on EPA’s “List P” for use against C. auris. If these aren’t available, use disinfectants that are active against C. diff spores. Also notify the outside facility about infection control strategies if C. auris is identified in a transferred patient. For more data, get our note, "Determine when to start EMPIRIC antifungals".

References

Treatment and Management of Infections and Colonization; Candida auris - Fungal Diseases - CDC. [online] Available at: https://www.cdc.gov/fungal/candida-auris/c-auris-treatment.html.
Lyman M, Forsberg K, Sexton DJ, Chow NA, Lockhart SR, Jackson BR, Chiller T. Worsening Spread of Candida auris in the United States, 2019 to 2021. Ann Intern Med. 2023 Apr;176(4):489-495. Available at: https://www.acpjournals.org/doi/10.7326/M22-3469.
Vallabhaneni S, Jackson BR, Chiller TM. Candida auris: An Emerging Antimicrobial Resistance Threat. Ann Intern Med. 2019 Sep 17;171(6):432-433. Available at: https://www.acpjournals.org/doi/10.7326/M19-2205.