title: Candida norvegensis fungemia in a liver transplant recipient.
abstract: BACKGROUND
  The incidence of candidemia due to non-Candida albicans Candida species has been progressively increasing in recent years. The use of fluconazole as antifungal prophylaxis has been described as a risk factor for the development of infections by fluconazole resistant Candida strains. We report a case of Candida norvegensis bloodstream infection in a liver transplant recipient.
  
  
  METHODS
  A 61-year-old man, who received a third liver allograft and became worse with the onset of ischemic cholangiopathy and recurrent episodes of cholangitis, was admitted to our hospital due to the development of intra-abdominal abscesses. He received multiple antibiotic schemes, and after 3 months he was discharged, maintaining parenteral antibiotic at home. While he was on fluconazole prophylaxis, a breakthrough candidemia due to C. norvegensis occurred. In vitro susceptibilities of the isolate to several antifungal agents were as follows: amphotericin B MIC 0.5 mg/l, flucytosine 64 mg/l, fluconazole 64 mg/l, itraconazole 4 mg/l, voriconazole 0.75 mg/l, and caspofungin 0.047 mg/l. He was treated with anidulafungin with resolution of candidemia.
  
  
  CONCLUSIONS
  The use of fluconazole for antifungal prophylaxis may lead to the emergence of fluconazole-resistant Candida infections, with C. norvegensis being a possible emerging pathogen in organ transplant recipients.
authors.affiliation: Department of Infectious Diseases, Hospital Clínic de Barcelona, University of Barcelona, Spain.
authors.forename: Gemma
authors.initials: G
authors.lastname: Sanclemente
authors.affiliation: Department of Microbiology, "Centre Diagnòstic Biomèdic" (CDB), Centre for International Health Research (CRESIB), Hospital Clínic de Barcelona, University of Barcelona, Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Marco
authors.affiliation: Department of Infectious Diseases, Hospital Clínic de Barcelona, University of Barcelona, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Cervera
authors.affiliation: Department of Infectious Diseases, Hospital Clínic de Barcelona, University of Barcelona, Spain.
authors.forename: Irma
authors.initials: I
authors.lastname: Hoyo
authors.affiliation: Department of Hepatology, Hospital Clínic de Barcelona, University of Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Colmenero
authors.affiliation: Department of Microbiology, "Centre Diagnòstic Biomèdic" (CDB), Centre for International Health Research (CRESIB), Hospital Clínic de Barcelona, University of Barcelona, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Pitart
authors.affiliation: Department of Microbiology, "Centre Diagnòstic Biomèdic" (CDB), Centre for International Health Research (CRESIB), Hospital Clínic de Barcelona, University of Barcelona, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Almela
authors.affiliation: Department of Hepatology, Hospital Clínic de Barcelona, University of Barcelona, Spain.
authors.forename: Miquel
authors.initials: M
authors.lastname: Navasa
authors.affiliation: Department of Infectious Diseases, Hospital Clínic de Barcelona, University of Barcelona, Spain. Electronic address: amoreno@clinic.ub.es.
authors.forename: Asunción
authors.initials: A
authors.lastname: Moreno
mesh_terms: D018784:Abdominal Abscess / Q000188:drug therapy / Q000382:microbiology; D000077612:Anidulafungin; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use; D001424:Bacterial Infections / Q000150:complications; D002175:Candida / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification*; D058387:Candidemia / Q000188:drug therapy / Q000382:microbiology*; D058365:Candidiasis, Invasive / Q000188:drug therapy / Q000382:microbiology*; D002761:Cholangitis / Q000150:complications; D021821:Communicable Diseases, Emerging / Q000382:microbiology; D026141:Drug Resistance, Multiple, Fungal; D054714:Echinocandins / Q000627:therapeutic use; D015725:Fluconazole / Q000009:adverse effects / Q000627:therapeutic use; D016469:Fungemia / Q000188:drug therapy / Q000382:microbiology*; D005704:Gallbladder / Q000098:blood supply; D006801:Humans; D007511:Ischemia / Q000150:complications; D008100:Liver Abscess / Q000150:complications / Q000382:microbiology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy / Q000382:microbiology*; D012086:Reoperation; D015163:Superinfection
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D054714:Echinocandins; D015725:Fluconazole; D000077612:Anidulafungin
keywords: Candida norvegensis; Fluconazol; Fluconazole; Fungemia; Liver transplant; Trasplante hepático