title: Selection of resistant fungi in liver transplant recipients during use of newer antifungal agents -- a report of two cases.
abstract: BACKGROUND
  Because invasive fungal infections cause significant morbidity and mortality in liver transplant recipients, the use of antifungal prophylaxis, and the early empirical use of antifungal agents, is widespread on liver transplant units. The new-generation azoles such as voriconazole and the echinocandins have been welcome additions to the antifungal armamentarium. These agents have become the leading options for prophylaxis in liver transplant units, despite the absence of strong data for their efficacy in this setting.
  
  
  METHODS
  We report two recipients of living-donor liver transplants who became infected/colonised with fungi resistant to an echinocandin and the azoles after exposure to these agents. One patient developed trichosporonosis while on caspofungin and the other became infected/ colonised with Candida glabrata that was resistant to voriconazole and posaconazole.
  
  
  CONCLUSIONS
  We report these to highlight some of the consequences of using the newer antifungal agents.
authors.affiliation: Department of Infectious Disease, Singapore General Hospital, Singapore. pushpalatha.bangalore.lingegowda@sgh.com.sg
authors.forename: Pushpalatha B
authors.initials: PB
authors.lastname: Lingegowda
authors.forename: Chee Kiat
authors.initials: CK
authors.lastname: Tan
authors.forename: Ai Ling
authors.initials: AL
authors.lastname: Tan
authors.forename: Ban Hock
authors.initials: BH
authors.lastname: Tan
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D000077336:Caspofungin; D025141:Drug Resistance, Fungal; D054714:Echinocandins / Q000627:therapeutic use; D017809:Fatal Outcome; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D055666:Lipopeptides; D016031:Liver Transplantation / Q000009:adverse effects / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy / Q000517:prevention & control*; D011743:Pyrimidines / Q000627:therapeutic use; D014230:Triazoles / Q000627:therapeutic use; D060586:Trichosporonosis / Q000188:drug therapy / Q000517:prevention & control; D065819:Voriconazole; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D011743:Pyrimidines; D014230:Triazoles; C101425:posaconazole; D015725:Fluconazole; D000077336:Caspofungin; D065819:Voriconazole