title: Echinocandin failure case due to a previously unreported FKS1 mutation in Candida krusei.
abstract: Echinocandins are the preferred therapy for invasive infections due to Candida krusei. We present here a case of clinical failure involving C. krusei with a characteristic FKS1 hot spot mutation not previously reported in C. krusei that was isolated after 14 days of treatment. Anidulafungin MICs were elevated by ≥ 5 dilution steps above the clinical breakpoint but by only 1 step for a Candida albicans isolate harboring the corresponding mutation, suggesting a notable species-specific difference in the MIC increase conferred by this mutation.
authors.affiliation: Mycology Unit, Statens Serum Institut, Copenhagen, Denmark.
authors.forename: Rasmus Hare
authors.identifier: 0000-0002-9796-023X
authors.initials: RH
authors.lastname: Jensen
authors.affiliation: Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark.
authors.forename: Ulrik Stenz
authors.initials: US
authors.lastname: Justesen
authors.affiliation: Department of Haematology, Odense University Hospital, Odense, Denmark.
authors.forename: Annika
authors.initials: A
authors.lastname: Rewes
authors.affiliation: Public Health and Research Institute, Rutgers University, Newark, New Jersey, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Perlin
authors.affiliation: Mycology Unit, Statens Serum Institut, Copenhagen, Denmark maca@ssi.dk.
authors.forename: Maiken Cavling
authors.initials: MC
authors.lastname: Arendrup
mesh_terms: D019943:Amino Acid Substitution; D000077612:Anidulafungin; D000935:Antifungal Agents / Q000494:pharmacology* / Q000627:therapeutic use; D002175:Candida / Q000187:drug effects / Q000235:genetics*; D002177:Candidiasis / Q000150:complications / Q000188:drug therapy / Q000382:microbiology*; D002544:Cerebral Infarction / Q000150:complications; D054714:Echinocandins / Q000494:pharmacology* / Q000627:therapeutic use; D017809:Fatal Outcome; D005260:Female; D005656:Fungal Proteins / Q000235:genetics; D005964:Glucosyltransferases / Q000235:genetics*; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D020125:Mutation, Missense; D017422:Sequence Analysis, DNA; D013045:Species Specificity; D017211:Treatment Failure
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D005656:Fungal Proteins; D000077612:Anidulafungin; D005964:Glucosyltransferases