Development of high-level echinocandin resistance in a patient with recurrent candida auris candidemia secondary to chronic candiduria

Mark J. Biagi, Nathan Wiederhold, Connie Gibas, Brian L Wickes, Victoria Lozano, Susan C. Bleasdale, Larry Danziger

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective. Candida auris is a globally emerging pathogen associated with significant mortality. This pathogen frequently is misidentified by traditional biochemical methods and is resistant to commonly used antifungals. The echinocandins currently are recommended as the first-line treatment for C. auris infections. The objective of this work is to demonstrate the challenges associated with C. auris in the real-world setting. Methods. A 54-year-old male presented to our institution for concerns of sepsis on multiple occasions over a 5-month period. Eleven urine cultures were positive over this timeframe for yeast (9 unidentified Candida isolates and 2 C. lusitaniae isolates). On day 27, the patient developed echinocandin-susceptible candidemia, which was initially identified as C. haemulonii but later accurately identified as C. auris at an outside mycology reference laboratory. Approximately 10 weeks later, the patient had a recurrence of candidemia, this time caused by an echinocandin-resistant C. auris strain. Results. Genomic DNA sequencing performed at the outside mycology reference laboratory identified a single serine to proline base pair change at position 639 (S639P) in the hotspot 1 region of the FKS1 gene of the echinocandin-resistant strain. Conclusions. Our experiences highlight 4 major concerns associated with C. auris: misidentification, persistent colonization, infection recurrence despite the receipt of appropriate initial therapy, and development of resistance.

Original languageEnglish (US)
Article number262
JournalOpen Forum Infectious Diseases
Volume6
Issue number7
DOIs
StatePublished - Jun 5 2019

Fingerprint

Echinocandins
Candidemia
Candida
Mycology
Recurrence
Infection
DNA Sequence Analysis
Proline
Base Pairing
Serine
Sepsis
Yeasts
Urine
Mortality
Therapeutics
Genes

Keywords

  • Antifungal resistance
  • CANDIDA auris
  • Candidemia
  • Echinocandin
  • Fks.

ASJC Scopus subject areas

  • Oncology
  • Clinical Neurology

Cite this

Development of high-level echinocandin resistance in a patient with recurrent candida auris candidemia secondary to chronic candiduria. / Biagi, Mark J.; Wiederhold, Nathan; Gibas, Connie; Wickes, Brian L; Lozano, Victoria; Bleasdale, Susan C.; Danziger, Larry.

In: Open Forum Infectious Diseases, Vol. 6, No. 7, 262, 05.06.2019.

Research output: Contribution to journalArticle

@article{90b2354692a94a59aeb424c314f582bd,
title = "Development of high-level echinocandin resistance in a patient with recurrent candida auris candidemia secondary to chronic candiduria",
abstract = "Objective. Candida auris is a globally emerging pathogen associated with significant mortality. This pathogen frequently is misidentified by traditional biochemical methods and is resistant to commonly used antifungals. The echinocandins currently are recommended as the first-line treatment for C. auris infections. The objective of this work is to demonstrate the challenges associated with C. auris in the real-world setting. Methods. A 54-year-old male presented to our institution for concerns of sepsis on multiple occasions over a 5-month period. Eleven urine cultures were positive over this timeframe for yeast (9 unidentified Candida isolates and 2 C. lusitaniae isolates). On day 27, the patient developed echinocandin-susceptible candidemia, which was initially identified as C. haemulonii but later accurately identified as C. auris at an outside mycology reference laboratory. Approximately 10 weeks later, the patient had a recurrence of candidemia, this time caused by an echinocandin-resistant C. auris strain. Results. Genomic DNA sequencing performed at the outside mycology reference laboratory identified a single serine to proline base pair change at position 639 (S639P) in the hotspot 1 region of the FKS1 gene of the echinocandin-resistant strain. Conclusions. Our experiences highlight 4 major concerns associated with C. auris: misidentification, persistent colonization, infection recurrence despite the receipt of appropriate initial therapy, and development of resistance.",
keywords = "Antifungal resistance, CANDIDA auris, Candidemia, Echinocandin, Fks.",
author = "Biagi, {Mark J.} and Nathan Wiederhold and Connie Gibas and Wickes, {Brian L} and Victoria Lozano and Bleasdale, {Susan C.} and Larry Danziger",
year = "2019",
month = "6",
day = "5",
doi = "10.1093/ofid/ofz262",
language = "English (US)",
volume = "6",
journal = "Open Forum Infectious Diseases",
issn = "2328-8957",
publisher = "Oxford University Press",
number = "7",

}

TY - JOUR

T1 - Development of high-level echinocandin resistance in a patient with recurrent candida auris candidemia secondary to chronic candiduria

AU - Biagi, Mark J.

AU - Wiederhold, Nathan

AU - Gibas, Connie

AU - Wickes, Brian L

AU - Lozano, Victoria

AU - Bleasdale, Susan C.

AU - Danziger, Larry

PY - 2019/6/5

Y1 - 2019/6/5

N2 - Objective. Candida auris is a globally emerging pathogen associated with significant mortality. This pathogen frequently is misidentified by traditional biochemical methods and is resistant to commonly used antifungals. The echinocandins currently are recommended as the first-line treatment for C. auris infections. The objective of this work is to demonstrate the challenges associated with C. auris in the real-world setting. Methods. A 54-year-old male presented to our institution for concerns of sepsis on multiple occasions over a 5-month period. Eleven urine cultures were positive over this timeframe for yeast (9 unidentified Candida isolates and 2 C. lusitaniae isolates). On day 27, the patient developed echinocandin-susceptible candidemia, which was initially identified as C. haemulonii but later accurately identified as C. auris at an outside mycology reference laboratory. Approximately 10 weeks later, the patient had a recurrence of candidemia, this time caused by an echinocandin-resistant C. auris strain. Results. Genomic DNA sequencing performed at the outside mycology reference laboratory identified a single serine to proline base pair change at position 639 (S639P) in the hotspot 1 region of the FKS1 gene of the echinocandin-resistant strain. Conclusions. Our experiences highlight 4 major concerns associated with C. auris: misidentification, persistent colonization, infection recurrence despite the receipt of appropriate initial therapy, and development of resistance.

AB - Objective. Candida auris is a globally emerging pathogen associated with significant mortality. This pathogen frequently is misidentified by traditional biochemical methods and is resistant to commonly used antifungals. The echinocandins currently are recommended as the first-line treatment for C. auris infections. The objective of this work is to demonstrate the challenges associated with C. auris in the real-world setting. Methods. A 54-year-old male presented to our institution for concerns of sepsis on multiple occasions over a 5-month period. Eleven urine cultures were positive over this timeframe for yeast (9 unidentified Candida isolates and 2 C. lusitaniae isolates). On day 27, the patient developed echinocandin-susceptible candidemia, which was initially identified as C. haemulonii but later accurately identified as C. auris at an outside mycology reference laboratory. Approximately 10 weeks later, the patient had a recurrence of candidemia, this time caused by an echinocandin-resistant C. auris strain. Results. Genomic DNA sequencing performed at the outside mycology reference laboratory identified a single serine to proline base pair change at position 639 (S639P) in the hotspot 1 region of the FKS1 gene of the echinocandin-resistant strain. Conclusions. Our experiences highlight 4 major concerns associated with C. auris: misidentification, persistent colonization, infection recurrence despite the receipt of appropriate initial therapy, and development of resistance.

KW - Antifungal resistance

KW - CANDIDA auris

KW - Candidemia

KW - Echinocandin

KW - Fks.

UR - http://www.scopus.com/inward/record.url?scp=85068647910&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85068647910&partnerID=8YFLogxK

U2 - 10.1093/ofid/ofz262

DO - 10.1093/ofid/ofz262

M3 - Article

VL - 6

JO - Open Forum Infectious Diseases

JF - Open Forum Infectious Diseases

SN - 2328-8957

IS - 7

M1 - 262

ER -