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. 2019 Jun 1;6(7):ofz262.
doi: 10.1093/ofid/ofz262. eCollection 2019 Jul.

Development of High-Level Echinocandin Resistance in a Patient With Recurrent Candida auris Candidemia Secondary to Chronic Candiduria

Mark J Biagi  1 , Nathan P Wiederhold  2 , Connie Gibas  2 , Brian L Wickes  3 , Victoria Lozano  3 , Susan C Bleasdale  4 , Larry Danziger  1
Affiliations

Development of High-Level Echinocandin Resistance in a Patient With Recurrent Candida auris Candidemia Secondary to Chronic Candiduria

Mark J Biagi et al. Open Forum Infect Dis. .

Abstract

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.

Keywords: Candida auris; FKS; antifungal resistance; candidemia; echinocandin.

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Figures

Figure 1.
Figure 1.
Timeline of Antifungal Therapy and Microbiologic Data.a Abbreviations: BCx, blood culture; EC-R1: echinocandin-resistant strain isolated on day 97; EC-S1: echinocandin-susceptible strain isolated on day 27; EC-S2: echinocandin-susceptible strain isolated on day 29; q6h: every 6 hours; UCx: urine culture. aPatient previously received micafungin at an outside hospital for an unknown duration prior to the initial presentation at our institution (day 0).
See this image and copyright information in PMC

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