title: Acquired Flucytosine Resistance during Combination Therapy with Caspofungin and Flucytosine for Candida glabrata Cystitis.
abstract: Treatment of Candida glabrata cystitis remains a therapeutic challenge, and an antifungal combination using flucytosine is one option. We describe two patients with refractory C. glabrata cystitis who failed flucytosine combined with caspofungin with early-acquired high-level resistance to flucytosine due to nonsense mutations in the FUR1 gene. Rapidly acquired flucytosine resistance with microbiological failure should discourage combination of caspofungin and flucytosine during urinary candidiasis.
authors.affiliation: Université Paris Descartes Sorbonne Paris Cité, Service de Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker-Pasteur, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Institut Imagine, Paris, France caroline.charlier@aphp.fr.
authors.forename: Caroline
authors.initials: C
authors.lastname: Charlier
authors.affiliation: Université Paris Descartes Sorbonne Paris Cité, Service de Microbiologie Clinique, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Carine
authors.initials: C
authors.lastname: El Sissy
authors.affiliation: Unité Biologie et Pathogénicité Fongiques, INRA, USC2019, Institut Pasteur, Paris, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Bachelier-Bassi
authors.affiliation: Université Paris Descartes Sorbonne Paris Cité, Service de Transplantation Rénale, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Scemla
authors.affiliation: Université Paris Descartes Sorbonne Paris Cité, Service de Microbiologie Clinique, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Quesne
authors.affiliation: Université Paris Descartes Sorbonne Paris Cité, Service de Microbiologie Clinique, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Sitterlé
authors.affiliation: Université Paris Descartes Sorbonne Paris Cité, Service de Transplantation Rénale, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Legendre
authors.affiliation: Université Paris Descartes Sorbonne Paris Cité, Service de Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker-Pasteur, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Institut Imagine, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Lortholary
authors.affiliation: Université Paris Descartes Sorbonne Paris Cité, Service de Microbiologie Clinique, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France Unité Biologie et Pathogénicité Fongiques, INRA, USC2019, Institut Pasteur, Paris, France.
authors.forename: Marie-Elisabeth
authors.initials: ME
authors.lastname: Bougnoux
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000008:administration & dosage*; D001483:Base Sequence; D041221:Candida glabrata / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification / Q000378:metabolism; D002177:Candidiasis / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D000077336:Caspofungin; D018389:Codon, Nonsense; D003556:Cystitis / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D025141:Drug Resistance, Fungal / Q000187:drug effects* / Q000235:genetics; D004359:Drug Therapy, Combination; D054714:Echinocandins / Q000008:administration & dosage*; D005260:Female; D005437:Flucytosine / Q000008:administration & dosage*; D005656:Fungal Proteins / Q000235:genetics / Q000378:metabolism; D015870:Gene Expression; D006801:Humans; D055666:Lipopeptides / Q000008:administration & dosage*; D008297:Male; D008969:Molecular Sequence Data; D033702:Nucleobase Transport Proteins / Q000235:genetics / Q000378:metabolism; D017211:Treatment Failure; D001743:Urinary Bladder / Q000382:microbiology / Q000473:pathology
chemical_list: D000935:Antifungal Agents; D018389:Codon, Nonsense; D054714:Echinocandins; D005656:Fungal Proteins; D055666:Lipopeptides; D033702:Nucleobase Transport Proteins; D005437:Flucytosine; D000077336:Caspofungin