Breakthrough candidemia due to multidrug-resistant Candida glabrata during prophylaxis with a low dose of micafungin

Antimicrob Agents Chemother. 2014;58(4):2438-40. doi: 10.1128/AAC.02189-13. Epub 2014 Jan 27.

Abstract

We identified a case of breakthrough candidemia in a 25-year-old patient receiving micafungin prophylaxis (50 mg/day). Five Candida glabrata isolates were obtained from blood cultures and were classified as multidrug-resistant isolates, since all of them exhibited high MICs for echinocandin and azole drugs. A mutation (S663F) in hot spot 1 of the FKS2 gene was found in all five isolates. This mutation yielded a 1,3-β-D-glucan synthase enzyme with highly reduced sensitivities to echinocandin drugs.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Amphotericin B / therapeutic use
  • Antifungal Agents / pharmacology
  • Antifungal Agents / therapeutic use*
  • Azoles / pharmacology
  • Candida glabrata / drug effects*
  • Candidemia / drug therapy*
  • Candidemia / microbiology*
  • Drug Resistance, Fungal
  • Echinocandins / pharmacology
  • Echinocandins / therapeutic use*
  • Fungal Proteins / genetics
  • Fungal Proteins / metabolism
  • Humans
  • Lipopeptides / therapeutic use*
  • Male
  • Micafungin
  • Microbial Sensitivity Tests
  • Molecular Sequence Data
  • Mutation

Substances

  • Antifungal Agents
  • Azoles
  • Echinocandins
  • Fungal Proteins
  • Lipopeptides
  • Amphotericin B
  • Micafungin

Associated data

  • GENBANK/KF211437
  • GENBANK/KF211438
  • GENBANK/KF211439
  • GENBANK/KF211440
  • GENBANK/KF211441
  • GENBANK/KF211442
  • GENBANK/KF211443
  • GENBANK/KF211444
  • GENBANK/KF211445
  • GENBANK/KF211446
  • GENBANK/KF211447
  • GENBANK/KF211448
  • GENBANK/KF211449
  • GENBANK/KF211450
  • GENBANK/KF211451
  • GENBANK/KF211452
  • GENBANK/KF211453
  • GENBANK/KF211454
  • GENBANK/KF211455
  • GENBANK/KF211456
  • GENBANK/KF305827
  • GENBANK/KF305828
  • GENBANK/KF305829
  • GENBANK/KF305830
  • GENBANK/KF305831