Emergence of disseminated candidiasis caused by<i>Candida krusei</i>during treatment with caspofungin: Case report and review of literature

Pelletier, René; Alarie, Isabelle; Lagacé, Réal; Walsh, Thomas J.

doi:10.1080/13693780500220415

Cited by 50 publications

(44 citation statements)

References 19 publications

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“…Importantly, 90 to 100% of the isolates of the last four species listed are classified as susceptible to all three echinocandins based on the Յ2-g/ml breakpoint. Although the reduced susceptibilities of species such as C. parapsilosis and C. guilliermondii relative to those of C. albicans, C. glabrata, and C. tropicalis have not proven to influence outcomes in the various clinical trials (13,16,20,26,40), reduced susceptibility may come into play when infections with these species involve the eye or central nervous system, where adequate free drug levels cannot be readily obtained (30,39). The echinocandin susceptibilities of isolates stratified by geographic region and by species are shown in Table 3.…”

Section: Resultsmentioning

confidence: 99%

“…Furthermore, they highlight the presence of less-susceptible species, such as C. parapsilosis and C. guilliermondii, the MICs for which may be 10-to 100-fold higher than those observed for C. albicans, C. glabrata, and C. tropicalis (2,25,38). Notably, sporadic treatment failures consistent with clinical resistance have been documented in association with socalled "high-MIC" isolates (i.e., MIC Ͼ 2 g/ml) (8,10,12,14,17,19,21,30,39). In each case, the MIC of the echinocandin used in treatment was shown to increase progressively during the course of therapy, and where investigated, a mutation in FKS1 was demonstrated in the high-MIC isolate (12,17,19).…”

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confidence: 99%

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In Vitro Susceptibility of Invasive Isolates of Candida spp. to Anidulafungin, Caspofungin, and Micafungin: Six Years of Global Surveillance

Pfaller¹,

Boyken²,

Hollis³

et al. 2008

J Clin Microbiol

341

103

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The echinocandins are being used increasingly as therapy for invasive candidiasis. Prospective sentinel surveillance for the emergence of in vitro resistance to the echinocandins among invasive Candida sp. isolates is indicated. We determined the in vitro activities of anidulafungin, caspofungin, and micafungin against 5,346 invasive (bloodstream or sterile-site) isolates of Candida spp. collected from over 90 medical centers worldwide from 1 January 2001 to 31 December 2006. We performed susceptibility testing according to the CLSI M27-A2 method and used RPMI 1640 broth, 24-h incubation, and a prominent inhibition endpoint for determination of the MICs. Of 5,346 invasive Candida sp. isolates, species distribution was 54% C. albicans, 14% C. parapsilosis, 14% C. glabrata, 12% C. tropicalis, 3% C. krusei, 1% C. guilliermondii, and 2% other Candida spp. Overall, all three echinocandins were very active against Candida: anidulafungin (MIC 50 , 0.06 g/ml; MIC 90 , 2 g/ml), caspofungin (MIC 50 , 0.03 g/ml; MIC 90 , 0.25 g/ml), micafungin (MIC 50 , 0.015 g/ml; MIC 90 , 1 g/ml). More than 99% of isolates were inhibited by <2 g/ml of all three agents. Results by species (expressed as the percentages of isolates inhibited by <2 g/ml of anidulafungin, caspofungin, and micafungin, respectively) were as follows: for C. albicans, 99.6%, 100%, and 100%; for C. parapsilosis, 92.5%, 99.9%, and 100%; for C. glabrata, 99.9%, 99.9%, and 100%; for C. tropicalis, 100%, 99.8%, and 100%; for C. krusei, 100%, 100%, and 100%; and for C. guilliermondii, 90.2%, 95.1%, and 100%. There was no significant change in the activities of the three echinocandins over the 6-year study period and no difference in activity by geographic region. All three echinocandins have excellent in vitro activities against invasive strains of Candida isolated from centers worldwide. Our prospective sentinel surveillance reveals no evidence of emerging echinocandin resistance among invasive clinical isolates of Candida spp.The echinocandin class of antifungal agents acts by inhibition of the synthesis of 1,3-␤-D-glucan in the fungal cell wall (31, 41). All three available echinocandins-anidulafungin (Pfizer), caspofungin (Merck), and micafungin (Astellas)-possess fungicidal activity against most species of Candida, including those resistant to polyenes (23) and to azoles (1, 3, 4, 7, 11, 18, 25, 26, 34-36, 41, 43). Caspofungin and anidulafungin have been approved by the U.S. Food and Drug Administration (FDA; years 2002 and 2006, respectively) for the treatment of invasive candidiasis, including candidemia (20, 40), and micafungin has been approved for the treatment of esophageal candidiasis (year 2005) (5). Although FDA approval of this drug for the treatment of candidemia is pending, micafungin has been shown to be safe and efficacious in the treatment of candidemia in recently published open-label (1, 26) and randomized (16, 28) clinical trials. These agents all provide excellent clinical efficacy coupled with low toxicity for the treatment of serious candidal...

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Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

In Vitro Susceptibility of Invasive Isolates of Candida spp. to Anidulafungin, Caspofungin, and Micafungin: Six Years of Global Surveillance

Pfaller¹,

Boyken²,

Hollis³

et al. 2008

J Clin Microbiol

341

103

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“…The activity of this class of antifungal agents against this MDR pathogen is encouraging; however, the reports of resistance developing to caspofungin during the treatment of C. krusei infection must be kept in mind. The reduced susceptibility to caspofungin in both cases was associated with the onset of clinically apparent fungal infection involving anatomic sites, such as the eye (10) or the central nervous system (33), where adequate free drug levels cannot be readily obtained. In such instances, the availability of an agent such as voriconazole, with both activity against the infecting organism and good penetration into ocular and cen- Amphotericin B 304 4 4 5 7 24 51 85 98 99 100 Flucytosine 254 1 1 1 1 2 5 8 26 93 99 99 Anidulafungin 121 49 92 99 99 100 Caspofungin 300 1 40 69 90 98 99 100 Micafungin 102 12 84 99 100 a Amphotericin B MICs were determined by Etest after 24 h of incubation.…”

Section: Discussionmentioning

confidence: 99%

“…tral nervous system sites, may be vital to a successful outcome (33). Continued monitoring of the susceptibility of C. krusei to voriconazole and the echinocandins is clearly warranted.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the echinocandins have been used based on their fungicidal activity and excellent in vitro activity against C. krusei (41,42,56,57). Whereas echinocandin antifungals such as caspofungin have been used successfully to treat several different infections involving C. krusei (21,28,31,34,50), there have been recent troubling reports of caspofungin failure in the treatment of C. krusei infections (10,15,33). Notably, Hakki et al (10) reported a strain of C. krusei from a leukemic patient that displayed reduced susceptibilities to caspofungin, anidulafungin, and micafungin.…”

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Candida krusei , a Multidrug-Resistant Opportunistic Fungal Pathogen: Geographic and Temporal Trends from the ARTEMIS DISK Antifungal Surveillance Program, 2001 to 2005

Pfaller¹,

Diekema

Gibbs³

et al. 2008

J Clin Microbiol

220

140

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Candida krusei is well known as a fungal pathogen for patients with hematologic malignancies and for transplant recipients. Using the ARTEMIS Antifungal Surveillance Program database, we describe geographic and temporal trends in the isolation of C. krusei from clinical specimens and the in vitro susceptibilities of 3,448 isolates to voriconazole as determined by CLSI (formerly NCCLS) disk diffusion testing. In addition, we report the in vitro susceptibilities of bloodstream infection isolates of C. krusei to amphotericin B (304 isolates), flucytosine (254 isolates), anidulafungin (121 isolates), caspofungin (300 isolates), and micafungin (102 isolates) as determined by CLSI broth microdilution methods. Geographic differences in isolation were apparent; the highest frequency of isolation was seen for the Czech Republic (7.6%) and the lowest for Indonesia, South Korea, and Thailand (0 to 0.3%). Overall, 83% of isolates were susceptible to voriconazole, ranging from 74.8% in Latin America to 92.3% in North America. C. krusei was most commonly isolated from hematology-oncology services, where only 76.7% of isolates were susceptible to voriconazole. There was no evidence of increasing resistance of C. krusei to voriconazole from 2001 to 2005. Decreased susceptibilities to amphotericin B (MIC at which 90% of isolates were inhibited [MIC 90 ], 4 g/ml) and flucytosine (MIC 90 , 16 g/ml) were noted, whereas 100% of isolates were inhibited by <2 g/ml of anidulafungin (MIC 90 , 0.06 g/ml), micafungin (MIC 90 , 0.12 g/ml) or caspofungin (MIC 90 , 0.25 g/ml). C. krusei is an uncommon but multidrugresistant fungal pathogen. Among the systemically active antifungal agents, the echinocandins appear to be the most active against this important pathogen.

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Taxogenomic analysis of a novel yeast species isolated from soil, Pichia galeolata sp. nov.

Opulente,

Langdon,

Jarzyna

et al. 2023

Yeast

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A novel budding yeast species was isolated from a soil sample collected in the United States of America. Phylogenetic analyses of multiple loci and phylogenomic analyses conclusively placed the species within the genus Pichia. Strain yHMH446 falls within a clade that includes Pichia norvegensis, Pichia pseudocactophila, Candida inconspicua, and Pichia cactophila. Whole genome sequence data were analyzed for the presence of genes known to be important for carbon and nitrogen metabolism, and the phenotypic data from the novel species were compared to all Pichia species with publicly available genomes. Across the genus, including the novel species candidate, we found that the inability to use many carbon and nitrogen sources correlated with the absence of metabolic genes. Based on these results, Pichia galeolata sp. nov. is proposed to accommodate yHMH446T (=NRRL Y‐64187 = CBS 16864). This study shows how integrated taxogenomic analysis can add mechanistic insight to species descriptions.

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Emergence of disseminated candidiasis caused byCandida kruseiduring treatment with caspofungin: Case report and review of literature

Cited by 50 publications

References 19 publications

In Vitro Susceptibility of Invasive Isolates of Candida spp. to Anidulafungin, Caspofungin, and Micafungin: Six Years of Global Surveillance

In Vitro Susceptibility of Invasive Isolates of Candida spp. to Anidulafungin, Caspofungin, and Micafungin: Six Years of Global Surveillance

Candida krusei , a Multidrug-Resistant Opportunistic Fungal Pathogen: Geographic and Temporal Trends from the ARTEMIS DISK Antifungal Surveillance Program, 2001 to 2005

Taxogenomic analysis of a novel yeast species isolated from soil, Pichia galeolata sp. nov.

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