Recommendations for Treatment and Prevention of Candida auris

Adults and Children ≥ 2 months of age

Consultation with an infectious disease specialist is highly recommended when caring for patients with C. auris infection.

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.

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 40 kg

Most strains of C. auris found in the United States have been susceptible to echinocandins although echinocandin-resistant isolates have been reported. Because this organism appears to develop resistance quickly, patients on antifungal treatment should be carefully monitored for clinical improvement and 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.

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.

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:

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, non-sterile body sites (e.g., urine, external ear, wounds, and respiratory specimens)

CDC does not recommend treatment of C. auris cultured from noninvasive sites 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 precautions should be used for all patients with C. auris, regardless of source of specimen.

Recommendations for Prevention of C. auris

In addition to prevention of transmission of C. auris through infection control, strategies to prevent C. auris may include antimicrobial stewardship and appropriate care of medical devices.

Antimicrobial stewardship

Many patients with C. auris infection or colonization received broad-spectrum antibacterial and antifungal drugs in the weeks before first culture yielding C. auris. Implementation of antimicrobial stewardship may help with prevent C. auris.

Appropriate care of medical devices

A majority of patients with C. auris infection or colonization have various types of invasive lines and tubes, including central venous catheters, urinary catheters and tracheostomy tubes. Appropriate care of these devices and ongoing assessment of need for these devices and prompt removal when no longer needed may help prevent C. auris. Appropriate care of medical devices includes strict adherence to recommended central venous catheter and urinary catheter insertion and maintenance practices and care of tracheostomy sites.