Comprehensive Review of Candidozyma (Candida) auris Management: Insights From the Society of Infectious Diseases Pharmacists

Candidozyma (Candida) auris has emerged over the past two decades as a formidable global health threat due to its multidrug resistance, persistence in healthcare environments, and rapid nosocomial spread. Recently reclassified into the genus Candidozyma based on phylogenomic analysis, C. auris poses major challenges for both clinical management and infection control. Its ability to tolerate heat, salinity, and disinfectants supports long-term survival on surfaces and medical devices, facilitating transmission. Biofilm formation further enhances virulence and resistance to antifungal therapy. Clinical presentations range from asymptomatic colonization to invasive infections, with mortality rates approaching 50%. Echinocandins remain an important first-line treatment option, but their fungistatic activity, limited tissue penetration, and emerging resistance contribute to suboptimal outcomes, highlighting the need for new agents and optimized dosing strategies. The role of triazoles and amphotericin B is significantly limited by resistance and associated toxicities, while newer agents such as ibrexafungerp, fosmanogepix, and rezafungin show promising in vitro activity but lack substantial supporting clinical data. Combination therapy may also offer potential benefit, though supporting evidence is sparse. Infection control methods including active surveillance, contact precautions, and environmental disinfection with sporicidal agents and avoidance of ineffective quaternary ammonium compounds are key to preventing the nosocomial spread of C. auris. Despite growing awareness, effective decolonization strategies are lacking, and recurrence and transmission continue to pose challenges. Ongoing efforts to refine antifungal therapy, improve rapid diagnostics, and strengthen infection control practices are essential to mitigating the spread of this pathogen and optimizing outcomes for patients.