What are the complications of Candida auris infection?

Question

Hello doctor,

My wife, who is 40 years old, has been hospitalized for 26 days with an invasive Candida auris infection that started from a surgical wound after emergency abdominal surgery but spread to the bloodstream. The infectious disease team seems extremely concerned and has her on multiple antifungals simultaneously (Micafungin, Amphotericin B, and Flucytosine) because the Candida auris showed resistance to everything else on testing. Despite intensive treatment, she still spikes fevers daily to 102-103, and recent cultures are still positive for Candida auris in wound drainage. The hospital placed her in strict isolation with specialized cleaning protocols and limited visitation. The surgical team is discussing removing the synthetic mesh placed during the original surgery as a possible reservoir for Candida auris infection. Most concerning is deterioration in organ function - kidney injury with creatinine rising from 0.8 to 2.4, and liver enzymes steadily climbing (ALT 278, AST 314). She's lost 29 pounds during hospitalization despite supplemental nutrition. The hospital infection control team warned that once discharged, she might remain colonized with Candida auris indefinitely, requiring special precautions at home and future healthcare encounters. Is Candida auris truly as dangerous as they're suggesting? What's a realistic timeline for clearing an invasive infection? How concerned should we be about permanent organ damage from either infection or treatments? What special precautions will we need at home, given we have three young children?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

I sincerely empathize with your family's situation. I will clarify the details using straightforward language to ensure you grasp the current circumstances and what lies ahead.

Candida auris is a resistant fungus that poses a serious risk of life-threatening infections, particularly for patients in hospitals or those with weakened immune systems. It can easily spread within healthcare settings, remain viable on surfaces for extended periods, and frequently withstand conventional antifungal treatments. Due to its ability to enter the bloodstream and affect organs, it can lead to sepsis and organ failure.
The infection originated from a surgical wound and has progressed to her bloodstream. She has a foreign object (mesh) that could be a source of infection. Her strain of Candida auris is resistant to most medications, prompting doctors to administer three potent antifungals. Her kidneys and liver are now compromised, potentially due to:
- The infection itself.
- The aggressive antifungal treatments.

This infection is extremely serious and poses a life-threatening risk, but she is receiving intensive and appropriate medical care. Eradicating invasive Candida auris may take several weeks to months. As long as blood cultures remain positive, the infection persists. If the mesh is infected, its removal may be essential for resolving the infection.

The risk of permanent organ damage:

Kidneys: Elevated creatinine levels may result from Amphotericin B (a type of antifungal drug known for kidney side effects). If damage continues, there may be a need for long-term kidney management or dialysis.
Liver: Increased ALT (alanine transaminase) /AST (aspartate aminotransferase) levels can stem from both the infection and medication toxicity. This may sometimes be reversible, but not always.

The longer the infection endures, the higher the likelihood of lasting damage.

Safeguarding the children and others:

Candida auris can exist on skin or within the body without causing symptoms, even post-treatment, a condition known as colonization. C. auris does not transmit as easily as COVID or the flu, but taking precautions is advisable:

Regular handwashing.
Disinfect surfaces with hospital-grade cleaners.
Keep wounds properly covered.
Avoid sharing personal items.

I hope this information helps you.

Feel free to ask further queries.

Thank you.