Clinical Treatment of C. auris infections

Key points

  • Echinocandins are the initial recommended treatment for adults and children over 2 months.
  • Amphotericin B deoxycholate at 1 mg/kg daily is the initial recommended treatment for infants under 2 months.
  • Reports of echinocandin-resistant and pan-resistant cases are increasing.
  • Investigational drugs may be considered for echinocandin-resistant and pan-resistant infections.
  • Only treat clinical infections. Do not treat patients without signs or symptoms of infection, regardless of screening test results.
Two doctors holding files and speaking to each other.

Practice recommendations

  • Consider consulting with an infectious disease specialist.
  • Consider patient characteristics for antifungal selection and dosing.
  • Carefully monitor patient response to treatment and adjust as needed..

All cases should be reported to state or local health departments.

Additional considerations, dosing details, and alternative treatments are explained below.

Treatment only recommended for clinical infection‎‎

CDC does not recommend treatment for C. auris for any patient without signs or symptoms of infection.



This includes both patients with C. auris colonization and patients with C. auris detected in noninvasive sites (i.e., respiratory tract or urine).

Adults and children over 2 months

Based on the limited data available to date, an echinocandin drug at the dose listed below is recommended initial therapy for treatment of C. auris infections.

A doctor standing next to a patient in bed connected to an IV.
Follow the recommended dosing for initial treatment of C. auris.

Neonates and infants younger than 2 months of age

The initial treatment recommendation is:

  • Amphotericin B deoxycholate, 1 mg/kg daily
    • if unresponsive, consider liposomal amphotericin B, 5mg/kg daily.

In exceptional circumstances, where central nervous system involvement has been definitively ruled out, use of echinocandins may be considered with caution at the following doses:

  • Caspofungin - 25 mg/m2/day IV (based on body surface area)
  • Micafungin- 10mg/kg/day IV

Long-term infection control‎‎

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.

Antimicrobial resistance and treatment considerations

While most strains of C. auris found in the United States are susceptible to echinocandins, reports of echinocandin-resistant and pan-resistant cases are increasing. Patients on antifungal treatment should be carefully monitored and susceptibility testing is recommended.

Treatment considerations for echinocandin-resistant and pan-resistant infections are based on limited evidence.

Echinocandin resistance

Consider treatment with liposomal amphotericin B (5 mg/kg daily) when:

  • Susceptibility testing indicates echinocandin resistance
  • Patients treated with echinocandins do not improve after 5 days.

Pan-resistance

Some strains are resistant to all three major classes of antifungals. Laboratory studies have found that combination antifungal treatment may be effective for pan-resistant infections but this was not evaluated in clinical settings.

Investigational drugs may be considered for patients with pan-resistant isolates.

Contact these companies to learn more about accessing the drugs through their expanded access programs:

Fosmanogepix: fosmanogepixEAP@WEPclinical.com

Ibrexafungerp: expandedaccess@scynexis.com

Resources

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 Candidiasisexternal icon.