Breakthrough candidemia due to multidrug-resistant Candida glabrata during prophylaxis with a low dose of micafungin.
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.
Laboratório Especial de Micologia, Disciplina de Infectologia, Universidade Federal de São Paulo, São Paulo, Brazil.
Fernando César
FC
Bizerra
Cristina
C
Jimenez-Ortigosa
Ana Carolina R
AC
Souza
Giovanni Luis
GL
Breda
Flávio
F
Queiroz-Telles
David S
DS
Perlin
Arnaldo L
AL
Colombo
D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001393:Azoles / Q000494:pharmacology; D041221:Candida glabrata / Q000187:drug effects*; D058387:Candidemia / Q000188:drug therapy* / Q000382:microbiology*; D025141:Drug Resistance, Fungal; D054714:Echinocandins / Q000494:pharmacology / Q000627:therapeutic use*; D005656:Fungal Proteins / Q000235:genetics / Q000378:metabolism; D006801:Humans; D055666:Lipopeptides / Q000627:therapeutic use*; D008297:Male; D000077551:Micafungin; D008826:Microbial Sensitivity Tests; D008969:Molecular Sequence Data; D009154:Mutation
D000935:Antifungal Agents; D001393:Azoles; D054714:Echinocandins; D005656:Fungal Proteins; D055666:Lipopeptides; D000666:Amphotericin B; D000077551:Micafungin