What antifungal drugs work effectively for Candida auris?

Question

Hello doctor,

My father (77) is in a nursing home recovering from hip surgery, and they just informed us that he has tested positive for Candida auris. He already has multiple health problems, poorly controlled diabetes (his last A1C was 9.8), heart failure, and now this fungal infection. The facility has moved him to an isolation room, and the staff entering wear full protective gear. They also mentioned that several other residents have the same infection, which is very concerning.

Dad has a surgical wound from his hip replacement that is healing slowly, as well as a feeding tube and a urinary catheter. The wound care nurse noticed whitish patches around the surgical site and inside his mouth. His temperature fluctuates throughout the day, ranging from normal to 101.5°F. The doctor at the facility started him on antifungal medication, but mentioned that treatment options are limited because Candida auris is resistant to most available drugs.

He seems more confused than usual, and according to the nurse, his kidney function tests are worsening. How serious is this infection for someone with his health conditions? Could it infect his new artificial hip joint? Should we consider moving him to a different facility or hospital that might have more experience dealing with this “superbug”?

We are very worried that this infection might be more dangerous than his original health problems, and we feel that we are not getting complete information from the current facility.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Candida auris is indeed a serious and challenging infection, especially in elderly patients with multiple health issues like your father. This fungal pathogen is known for its resistance to many common antifungal medications, which makes treatment difficult and increases the risk of complications.

Given your father’s poorly controlled diabetes, heart failure, and the presence of a feeding tube and urinary catheter, he is at higher risk for severe infection. The whitish patches around his surgical wound and in his mouth, along with fluctuating fever and worsening kidney function, suggest that the infection may be systemic or spreading beyond the initial site. There is also a real risk that Candida auris could infect his prosthetic hip joint, which would complicate recovery and require more aggressive management.

Isolation and strict infection control measures at the facility are important to prevent the spread of infection to other residents and staff, but your concerns about the quality of care and the facility’s experience with this infection are valid. Given the complexity of Candida auris infections and your father’s fragile condition, seeking a second opinion from a specialized infectious disease center or transferring him to a hospital with expertise in managing multidrug-resistant infections could be beneficial.

I recommend discussing this with his current medical team and arranging a consultation with an infectious disease specialist as soon as possible to ensure the best possible care plan. Close monitoring, appropriate antifungal therapy, and supportive care are crucial to improving outcomes in such cases.

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.