My wife has Candida auris. How to manage it in elderly patients?

Question

Hi doctor,

My 68-year-old wife was just diagnosed with Candida auris infection following her major abdominal surgery three weeks ago. The hospital has moved her to isolation and implemented all kinds of strict protocols that have us terrified.

My wife has multiple health issues: poorly controlled type 2 diabetes (A1C 9.8), heart failure, and chronic kidney disease with a GFR of 42. Her surgical wound from small bowel resection never healed properly and has been draining purulent fluid for over a week.

They have cultured Candida auris from both the wound and her bloodstream, which the doctors say is extremely concerning. Her fever has been fluctuating between 100.8 and 103.2 degrees Fahrenheit despite three different antibiotics.

They have started her on an echinocandin antifungal through her PICC line, but mentioned this particular strain is showing reduced susceptibility to some medications. Her white blood cell count is 21.6, and she is becoming increasingly confused, which they say could be from the infection itself.

The infectious disease doctor mentioned a mortality rate of 30 percent to 60 percent for patients with her combination of conditions, which has me terrified. The hospital has implemented special cleaning protocols and limited visitors to just me, requiring full protective gear.

She has several medical devices, such as a PICC line, feeding tube, and urinary catheter. All possible sources for fungal colonization. The doctors seemed extremely concerned but would not give me a straight answer about her prognosis.

Given her age and multiple health problems, what are her chances of surviving this infection?
How long might treatment continue?
Will she need to remain isolated indefinitely?

Kindly help.

Answer 1

Hi,

Welcome to icliniq.com.

I can understand your concern.

I am sorry your wife is going through this.

Candida auris is a serious fungal infection, especially because your wife has other health problems. It is hard to treat, but she is on medication (antifungals) to help fight it. The doctors are worried because she is not improving quickly, but they are doing everything possible. Treatment could take weeks.

She will need to stay in isolation to avoid spreading the infection. Stay in contact with the doctors for updates. Help her stay as comfortable as possible. Keep everything clean at home to avoid other infections. It is a tough situation, but with the right care, she has a chance to get better.

I hope this information helps you.

Thanks.