Development of High-Level Echinocandin Resistance in a Patient With Recurrent Candida auris Candidemia Secondary to Chronic Candiduria
Development of High-Level Echinocandin Resistance in a Patient With Recurrent Candida auris Candidemia Secondary to Chronic Candiduria
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DOI：
10.1093/ofid/ofz262
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发表时间：
2019-07-01
影响因子：
4.2
通讯作者：
Danziger, Larry
中科院分区：
文献类型：
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作者：
Biagi, Mark J.;Wiederhold, Nathan P.;Danziger, Larry
Objective.耳念珠菌是一种全球新兴的病原体，与显著的死亡率相关。这种病原体经常被传统的生物化学方法错误识别，并且对常用的抗真菌药物具有耐药性。棘白菌素类药物目前被推荐作为治疗C.耳感染。这项工作的目的是展示与C。方法.一名54岁男性在5个月内多次因脓毒症到我院就诊。在此时间段内，11例尿培养酵母菌阳性（9例未鉴定的念珠菌分离株和2例C. lusitaniae isolates）。第27天，患者出现棘白菌素敏感性念珠菌血症，最初确定为C。haemulonii，但后来被准确地鉴定为C.在外部真菌学参考实验室进行。大约10周后，患者的念珠菌血症复发，这次是由棘白菌素耐药的念珠菌引起的。结果：在外部真菌学参考实验室进行的基因组DNA测序确定了棘白菌素耐药菌株FKS 1基因热点1区第639位（S639P）的单个丝氨酸至脯氨酸碱基对变化。我们的经验突出了与C相关的4个主要问题。耳：错误识别、持续定植、尽管接受了适当的初始治疗但感染复发以及耐药性的发展。
Objective. Candida auris is a globally emerging pathogen associated with significant mortality. This pathogen frequently is misidentified by traditional biochemical methods and is resistant to commonly used antifungals. The echinocandins currently are recommended as the first-line treatment for C. auris infections. The objective of this work is to demonstrate the challenges associated with C. auris in the real-world setting.Methods. A 54-year-old male presented to our institution for concerns of sepsis on multiple occasions over a 5-month period. Eleven urine cultures were positive over this timeframe for yeast (9 unidentified Candida isolates and 2 C. lusitaniae isolates). On day 27, the patient developed echinocandin-susceptible candidemia, which was initially identified as C. haemulonii but later accurately identified as C. auris at an outside mycology reference laboratory. Approximately 10 weeks later, the patient had a recurrence of candidemia, this time caused by an echinocandin-resistant C. auris strain.Results. Genomic DNA sequencing performed at the outside mycology reference laboratory identified a single serine to proline base pair change at position 639 (S639P) in the hotspot 1 region of the FKS1 gene of the echinocandin-resistant strain.Conclusions. Our experiences highlight 4 major concerns associated with C. auris: misidentification, persistent colonization, infection recurrence despite the receipt of appropriate initial therapy, and development of resistance.