Resistance to Echinocandins Complicates a Case of Candida albicans Bloodstream Infection: A Case Report

Abstract

Invasive candidiasis is known to be one of the most common healthcare-associated complications and is caused by several Candida species. First-line drugs, particularly echinocandins, are effective, but there are increasing reports of resistance to these molecules, though rarely related to C. albicans. Even though the rate of echinocandins resistance remains low (<3%), sporadic cases are emerging. Here, we present a case of bloodstream infection by a pan-echinocandin-resistant Candida albicans affecting a critically ill patient, who died in an intensive care unit following therapeutic failure and multiple organ dysfunction syndrome. This case highlights the need to suspect pan-echinocandin resistance in patients with prolonged echinocandin exposure, particularly in the presence of urinary tract colonization. Our study shows the importance of sequencing to predict therapeutic failure in patients treated with echinocandins and persistent candidemia.

Comparison between EUCAST Broth Microdilution and MIC Strip Test in Defining Isavuconazole In Vitro Susceptibility against Candida and Rare Yeast Clinical Isolates

“…Echinocandin resistance is also increasing, especially in C. glabrata and C. albicans. This kind of resistance is caused by prolonged echinocandin administration in the case of fungemia [22]. Furthermore, rare yeast isolates could also express antimicrobic resistance.…”

“…Isavuconazole powder (Basilea Pharmaceutica Ltd., Basel, Switzerland), was dissolved in dimethyl sulfoxide (DMSO) to reach a concentration of 1600 mg/L, ideal to keep the antifungal range within 0.008-4 mg/L. ATCC control strains such as C. krusei (6528) and C. parapsilosis (22,019) were also tested. Growth control and sterility control were added for each tested microorganism.…”

Micafungin Is an Efficient Treatment of Multi Drug-Resistant Candida glabrata Urosepsis: A Case Report

“…Candida resistant to ≥1 agent in ≥2 drug classes is considered to be multi drug-resistant [ 15 ]. Multi drug-resistant C. glabrata has become common in many hospitals and medical centers and possesses serious management challenge [ 15 , 16 ]. Also in our case, cultivation results confirmed C. glabrata isolate to be multi drug-resistant (to the azole, fluconazole, and to the echinocandins, anidulafungin and caspofungin).…”

Comprehensive Overview of Candida auris: An Emerging Multidrug-Resistant Fungal Pathogen

“…Consequently, the fungal cell becomes structurally compromised and vulnerable to osmotic stress. In C. albicans , resistance to echinocandins has been associated with the presence of specific mutations within two regions of the FKS1 and FKS2 genes [ 59 ]. These mutations have been identified as key factors contributing to echinocandin resistance.…”