Successful Treatment of Fungemia Caused byCyberlindnera fabianiiwith Anidulafungin: A Case Report

Abstract

Cyberlindnera fabianii (previously known as Hansenula fabianii, Pichia fabianii, and Lindnera fabianii) is a yeast species that forms a biofilm, allowing it to resist azole drugs. In this study, we report a case of fungemia with C. fabianii that was successfully treated with anidulafungin. In this case, the organism was initially misidentified as Candida utilis (with a high probability of 93%, suggesting good identification) using the VITEK 2 yeast identification card (YST ID; bioMérieux, USA). The species responsible for the patient's fungemia was correctly identified after sequencing the internally transcribed spacer region and the D1/D2 domain of the large subunit (26S) rDNA gene. The CLSI M27-A3 broth microdilution method was used to determine the in vitro antifungal activity of anidulafungin and fluconazole against C. fabianii. The MICs of anidulafungin and fluconazole were found to be 0.03 μg/mL and 2 μg/mL, respectively. The patient recovered after 14 days of anidulafungin treatment. (Ann Clin Microbiol 2015;18:94-97)

Identification and Antifungal Susceptibility Profiles of Cyberlindnera fabianii in Korea

“…In South Korea, there have been three case reports of Cy. fabianii from bloodstream [4,6,7]. In a recent survey of Czech hospitals, Cy.…”

“…Until now in Korea, Cy. fabianii isolates originated only from bloodstream and antifungal susceptibility testing was conducted on one isolate using anidulafungin [6]. Thus, it is the first report to perform in vitro antifungal susceptibility test using nine antifungal agents in order to select appropriate and effective antifungal therapy and supervise the development of resistance.…”

“…There have been three case reports of Cy. fabianii, which were all isolated from bloodstream [4,6,7]. In addition, as part of a project of fungal pathogen culture collection in International St. Mary's Hospital during 2016-2017, eleven isolates from eleven patients with different clinical histories were obtained.…”

Cyberlindnera fabianii fungaemia outbreak in preterm neonates in Kuwait and literature review

“…Among these emerging Candida spp., C. fabianii (anamorph Candida fabianii) is one such species, which exhibits reduced susceptibility to fluconazole, itraconazole and posaconazole . Until September 2017, 21 patients with C. fabianii infection (including 14 patients with fungaemia) have been reported from different countries across Asia (n = 6), Europe (n = 12) and America (n = 3) (Table ) . Similar to our study, nearly half of these cases also occurred in paediatric age group, mostly including neonates (n = 7).…”

“…All the patients responded favourably with cultures becoming negative between 15 and 40 days following therapy . Echinocandins have also recently been used for the treatment of C. fabianii infection in some patients, and the therapeutic response has been generally good (Table ) . In this regard, Lee et al reported an interesting case of C. fabianii fungaemia in an 87‐year‐old man with lung cancer .…”