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Can Candida Auris be treated successfully in high-risk cases?

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Patient's Query

Hello doctor,

My 78-year-old father was recently diagnosed with a Candida auris infection following coronary bypass surgery performed three weeks ago. Since the diagnosis, he has been moved to isolation, and the medical team appears deeply concerned. He has several serious underlying conditions, including poorly controlled diabetes (A1C 10.2), stage 3 chronic kidney disease (GFR 34), and heart failure with an ejection fraction of 30 percent. His surgical wound has not healed properly and has been draining purulent fluid for the past week.

Cultures from both the wound and his blood have confirmed Candida auris, which the team says is particularly worrisome due to its resistance to multiple antifungal medications. Despite being on three different antibiotics, his fever continues to fluctuate between 100.5 °F and 103.8 °F. He has now been started on an echinocandin antifungal via PICC (Peripherally inserted central catheter) line, but we were informed that resistance remains a significant concern.

Additionally, he is experiencing severe confusion and agitation, which they believe may be infection-related. His white blood cell count is elevated at 22.4, and his blood pressure is unstable, currently at 92/58 mmHg.

The hospital has implemented strict contact precautions, requiring gowns, gloves, and masks for all visitors. When I tried to look up information on Candida auris, much of what I found was alarming. The infectious disease specialist mentioned a high mortality rate, which is deeply distressing.

Given his age and multiple comorbidities, what is the realistic outlook for his recovery? Will continued isolation be necessary even if he improves? The team also mentioned the potential removal of his pacemaker due to concerns about biofilm-related infection. Should family members be tested or take special precautions? The cardiac surgeon expressed significant concern about infection control in the ICU. Please help.

Thank you.

Answered by Dr. Fizza Noor

Hi,

Welcome to icliniq.com.

I read your query and can understand your concern.

The patient is a 77-year-old male who was recently diagnosed with Candida auris (a rare but serious fungal infection caused by a yeast that can lead to severe illness, especially in people who are already hospitalized or have weakened immune systems). The bloodstream infection occurred following coronary artery bypass surgery, which is a common heart procedure used to improve blood flow to the heart muscle. It is usually performed when one or more of the coronary arteries, which supply oxygen-rich blood to the heart, become narrowed or blocked due to a buildup of plaque. performed three weeks ago. He has significant comorbidities, including poorly controlled type 2 diabetes (HbA1c -10.2), stage 3 chronic kidney disease glomerular filtration rate (GFR - 34), and heart failure with a reduced ejection fraction (EF 30 %), which is a percentage of blood that is pumped out of the heart's left ventricle with each contraction. It is a key measurement used to assess how well the heart is functioning, particularly in individuals with heart disease.

His surgical wound is draining pus-filled liquid, and cultures from both the wound and blood have confirmed Candida auris. He is currently feverish (temperature ranging from 100.5 °F to 103.8 °F), has low blood pressure (BP 92/58 mmHg), and is leukocytotic (WBC 22.4 µL) is an increase in the number of white blood cells (leukocytes) in the blood. Additionally, he is exhibiting neurological changes, including confusion and agitation, suggestive of encephalopathy (disease of the brain that leads to altered mental status).

He has been initiated on echinocandin antifungal therapy(antifungal medications that are primarily used to treat severe fungal infections ) via a PICC line (peripherally inserted central catheter an IV (Intravenous) inserted into a vein in the arm, extending to a larger vein near the heart, providing long-term access for medications, fluids, and blood draws). Due to concerns about possible pacemaker colonization, further evaluation is underway. The patient is currently in isolation, and appropriate infection prevention and control measures are being strictly observed.

I hope this helps.

Thank you.

The Probable causes

Nosocomial fungal infection following cardiac surgery Immunosuppression from uncontrolled diabetes, CKD, and CHF Broad-spectrum antibiotic exposure Presence of invasive devices (PICC line, pacemaker) Poor wound healing and prolonged hospitalization

Investigations to be done

Repeat blood and wound cultures Antifungal susceptibility testing Transthoracic or transesophageal echocardiogram (to assess pacemaker involvement or endocarditis) Renal and liver function tests CRP, Procalcitonin Wound imaging (Ultrasound/MRI if abscess suspected) Electrolytes, lactate levels Daily CBC and hemodynamic monitoring

Differential diagnosis

Sepsis due to bacterial infection

Endocarditis (fungal or bacterial) involving pacemaker leads

Hospital-acquired pneumonia

Surgical wound abscess or necrotizing infection

Delirium due to sepsis or metabolic imbalance

Probable diagnosis

Systemic Candida auris candidemia with possible device-related infection (pacemaker) and surgical site fungal wound infection in an immunocompromised post-operative patient.

Treatment plan

Continue echinocandin (micafungin or caspofungin); consider liposomal Amphotericin B if resistance or poor response Monitor renal function and adjust doses accordingly Consider pacemaker removal if colonization or endocarditis confirmed Strict isolation and barrier precautions Supportive care: IV fluids, vasopressors if needed, antipyretics Surgical wound debridement if indicated Repeat cultures every 48–72 hours to confirm clearance Multidisciplinary approach: Infectious disease, cardiology, surgery

Preventive measures

Strict hand hygiene and PPE usage by staff and visitors Environmental disinfection and equipment sterilization Minimize use of invasive lines/devices when possible Monitor ICU contacts per hospital infection control protocols Educate family regarding transmission prevention

Regarding follow up

Serial blood cultures until negative Monitor wound healing and systemic symptoms Assess antifungal treatment response clinically and via labs Long-term follow-up with infectious disease and cardiology Pacemaker reassessment post-treatment Assess for colonization status after discharge

Answered byDr. Fizza Noor

Medically reviewed byiCliniq medical review team

Published At July 7, 2025
Reviewed AtJuly 11, 2025

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Fizza Noor
Dr. Fizza Noor

Pediatric Allergy/Asthma Specialist

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