How to manage Candida auris infection in ICU?

Question

Hello Doctor,

My friend’s mother, who is 69 years old, diabetic, and was recently in the intensive care unit (ICU), has been diagnosed with candida auris. We are hearing a lot of alarming information about this infection, particularly regarding its resistance to treatment.

The doctors have started treatment with Echinocandin, but now they are considering switching to Amphotericin B. We are trying to understand how serious this infection is and what her chances of recovery might be.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Candida auris is a type of fungus that can cause serious infections, especially in individuals who are already very ill, such as those in the intensive care unit (ICU). It is particularly concerning because:

It is often resistant to multiple antifungal medications.

It can spread easily in healthcare settings.

It can be life-threatening in vulnerable individuals, such as the elderly or those with comorbidities like diabetes.

Echinocandins, such as Micafungin (Antifungal - Echinocandin class) or Caspofungin (Antifungal - Echinocandin class), are usually the first-line treatment for candida auris. They are chosen because:

Many strains of candida auris are still susceptible to them.

They tend to be safer and better tolerated than other antifungal medications.

Amphotericin B (Antifungal - Polyene class) might be considered because:

Her strain of candida auris may not be responding adequately to Echinocandins.

The infection may be progressing or may be located in a critical area, such as the bloodstream.

Amphotericin B has a broader antifungal spectrum and is more potent — although it is associated with more side effects, such as kidney toxicity, which is a concern in someone who is already critically ill.

Unfortunately, this is a serious situation — particularly given:

Her age (69 years old).

Underlying diabetes.

Recent ICU stay, suggesting she is already weakened or had a serious illness.

A difficult-to-treat fungal infection.

Mortality rates for invasive candida auris infections in critically ill patients can range from 30% to 60%, depending on other factors such as organ function, immune status, and how quickly effective treatment is initiated.

However, there is hope:

If her doctors identified the infection early and are adjusting treatment based on susceptibility, that is a positive sign.

Being in the ICU means she is receiving close monitoring and supportive care.

Some patients do recover, especially if the infection has not spread extensively and if she is stable enough to tolerate antifungal treatment.

I hope this helps.

Thank you.