What agent and for how long would you treat a patient with asymptomatic azole-resistant C auris candiduria who is planning to undergo a urological procedure?
Answer from: at Academic Institution
I would be cautious here. If there are reasonable MICs to fluconazole (SDD but achievable), this would be preferred. Intravesical amphotericin is a good option. But, if this were impossible to achieve, I would be reluctant to use IV amphotericin in any formulation, since there's a risk of harm, and ...
Overall, it would depend on the resistance profile regarding the exact agent. However, I would use either an azole (if sensitive) or do amphotericin bladder washes (or, if not possible, would possibly need to give IV ambisome) for 24 hours prior to and 24 hours after the procedure.
This is an extremely complicated question due to the nature of C auris, and I have no simple answer (as I would if it was about E coli). Is this a woman with asymptomatic candiduria, a man with possible prostate involvement? And what is the procedure - and the risk for post-procedure infection? And ...