title: [First case report of catheter-related fungemia by Candida nivariensis in the Iberian Peninsula].
abstract: BACKGROUND
  In recent years the incidence of candidemia caused by non-albicans Candida species has been increasing. Two cryptic species have been described within the Candida glabrata complex, Candida nivariensis and Candida bracarensis, which may be troublesome in laboratory identification and have lower susceptibility to fluconazole.
  
  
  OBJECTIVE
  To describe the first isolation of C. nivariensis in the Iberian Peninsula from a patient suffering from a catheter-related fungemia.
  
  
  METHODS
  An 81-year-old man was hospitalized for surgical treatment of an intestinal fistula that was associated to a severe malnutrition. Cultures of the patient's central venous catheter tip and blood yielded white colonies in BD CHROMagar Candida(®) medium, which could not be identified by conventional microbiological methods. Although intravenous fluconazole was administered, blood cultures continued being positive 5 days later. The MIC values of the isolate were as follows: 1 μg/ml for amphotericin B, 0.015 μg/ml for anidulafungin, 0.125 μg/ml for caspofungin, 0.015 μg/ml for micafungin, 4 μg/ml for fluconazole, 0.25 μg/ml for itraconazole, 0.25 μg/ml for posaconazole, and 0.03 μg/ml for voriconazole. Antifungal treatment was changed to intravenous caspofungin for 2 weeks. The intestinal fistula was surgically treated. There was no evidence of relapse during the following month, and the patient was discharged. The isolate was identified as C. nivariensis based on DNA sequencing of the ITS regions of rRNA.
  
  
  CONCLUSIONS
  C. nivariensis should be regarded as an emerging pathogen which requires molecular methods for a definitive identification. Our patient was successfully treated with caspofungin.
authors.affiliation: Servicio de Microbiología, Hospital Universitario Cruces, Barakaldo, Bizkaia, España. leyremonica.lopezsoria@osakidetza.net
authors.forename: Leyre M
authors.initials: LM
authors.lastname: López-Soria
authors.forename: Elena
authors.initials: E
authors.lastname: Bereciartua
authors.forename: Marta
authors.initials: M
authors.lastname: Santamaría
authors.forename: Luis Miguel
authors.initials: LM
authors.lastname: Soria
authors.forename: José Luis
authors.initials: JL
authors.lastname: Hernández-Almaraz
authors.forename: Alessandra
authors.initials: A
authors.lastname: Mularoni
authors.forename: Javier
authors.initials: J
authors.lastname: Nieto
authors.forename: Miguel
authors.initials: M
authors.lastname: Montejo
mesh_terms: D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use; D002175:Candida / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000254:growth & development / Q000302:isolation & purification*; D058387:Candidemia / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D000077336:Caspofungin; D055499:Catheter-Related Infections / Q000188:drug therapy / Q000382:microbiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects; D003108:Colonic Diseases / Q000150:complications; D026141:Drug Resistance, Multiple, Fungal; D054714:Echinocandins / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D016867:Immunocompromised Host; D007412:Intestinal Fistula / Q000150:complications; D007579:Jejunal Diseases / Q000150:complications; D055666:Lipopeptides; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000628:therapy; D016533:Mycological Typing Techniques; D009172:Mycology / Q000379:methods; D010288:Parenteral Nutrition / Q000295:instrumentation; D013030:Spain / Q000453:epidemiology; D013045:Species Specificity
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000077336:Caspofungin