Candida Auris: Which Antifungal Treatments Still Work?

Why does Candida auris matter after the COVID-19 pandemic?

The CDC's review of COVID-19 and antimicrobial resistance documents a sharp increase in reported US clinical cases of Candida auris: nearly fivefold between 2019 and 2022. These are historical surveillance findings, rather than a measurement of infections occurring this October. During the pandemic, staffing shortages, prolonged hospital stays and greater use of invasive devices strained infection prevention. [CDC pandemic resistance review](https://www.cdc.gov/antimicrobial-resistance/data-research/threats/covid-19.html)

C. auris is a yeast that can cause bloodstream and other invasive infections. Patients requiring complex care, central lines or ventilators are particularly vulnerable. It can also persist on patients' skin without causing illness and spread through contaminated equipment and surfaces. Consequently, effective medicines must be accompanied by reliable identification, screening and infection control. [CDC clinical overview](https://www.cdc.gov/candida-auris/hcp/clinical-overview/index.html)

Which antifungal medicines are recommended for Candida auris?

The recommended initial options include micafungin, caspofungin and anidulafungin, administered intravenously. Most US strains remain susceptible to this drug class, but reports of resistance are increasing. Laboratory susceptibility testing helps clinicians assess which medicines may work, while monitoring establishes whether the patient is responding. Treatment selection also depends on individual clinical circumstances. [CDC treatment guidance](https://www.cdc.gov/candida-auris/hcp/clinical-care/index.html)

When testing identifies echinocandin resistance, or a patient fails to improve after five days, CDC advises considering liposomal amphotericin B. Strains resistant to all three major antifungal classes create an especially difficult problem. CDC identifies investigational treatments, including fosmanogepix, as potential options through expanded access pathways. These decisions require specialist involvement because evidence for resistant infections remains limited. [CDC guidance on resistant infections](https://www.cdc.gov/candida-auris/hcp/clinical-care/index.html)

What does the fosmanogepix trial actually show?

A phase 2 study published in Antimicrobial Agents and Chemotherapy in 2023 enrolled nine adults with C. auris bloodstream infections. All received intravenous fosmanogepix. An independent committee assessed eight participants as treatment successes at the end of therapy, and eight were alive at day 30. These are preliminary findings from an earlier study, not newly announced results. [Published phase 2 trial](https://pmc.ncbi.nlm.nih.gov/articles/PMC10190264/)

The study had no comparison group, and every participant had received an echinocandin before fosmanogepix. Six participants had sustained treatment success two weeks after therapy ended; one experienced relapse and another died during follow-up. The small sample cannot reliably establish comparative benefit or detect uncommon adverse effects. Its practical contribution is evidence supporting further investigation, rather than proof that fosmanogepix should replace established antifungals. [Trial outcomes and limitations](https://pmc.ncbi.nlm.nih.gov/articles/PMC10190264/)