Acquired multidrug antifungal resistance in Candida lusitaniae during therapy
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Candida lusitaniae is usually susceptible to echinocandins. Beta-1,3-glucan synthase encoded by FKS genes is the target of echinocandins. A few missense mutations in the C. lusitaniae FKS1 hot spot 1 (HS1) have been reported. We report here the rapid emergence of antifungal resistance in C. lusitaniae isolated during therapy with amphotericin B (AMB), caspofungin (CAS), and azoles for treatment of persistent candidemia in an immunocompromised child with severe enterocolitis and visceral adenoviral disease. As documented from restriction fragment length polymorphism (RFLP) and random amplified polymorphic DNA (RAPD) analysis, the five C. lusitaniae isolates examined were related to each other. From antifungal susceptibility and molecular analyses, 5 different profiles (P) were obtained. These profiles included the following: profile 1 (P1) (CAS MIC [μg/ml], 0.5; fluconazole [FLC] MIC, 0.25), determined while the patient was being treated with liposomal AMB for 3 months; P2 (FLC MIC [μg/ml], 0.25; CAS MIC, 4), while the patient was being treated with CAS for 2 weeks; P3 (CAS MIC [μg/ml], 0.5; FLC MIC, 32), while the patient was being treated with azoles and CAS initially followed by azoles alone for a week; P4 (CAS MIC [μg/ml], 8; FLC MIC, 8), while the patient was being treated with both drugs for 3 weeks; and P5 (AMB MIC [μg/ml], 0.125; CAS MIC, 8), while the patient was being treated with AMB and FLC for 2 weeks. CAS resistance was associated with resistance not only to micafungin and anidulafungin but also to AMB. Analysis of CAS resistance revealed 3 novel FKS1 mutations in CAS-resistant isolates (S638Y in P2; S631Y in P4; S638P in P5). While S638Y and -P are within HS1, S631Y is in close proximity to this domain but was confirmed to confer candin resistance using a site-directed mutagenesis approach. FLC resistance could be linked with overexpression of major facilitator gene 7 (MFS7) in C. lusitaniae P2 and P4 and was associated with resistance to 5-flurocytosine. This clinical report describes resistance of C. lusitaniae to all common antifungals. While candins or azole resistance followed monotherapy, multidrug antifungal resistance emerged during combined therapy.
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Multidrug resistance is not restricted to C. glabrata or C. auris; other examples include C. kefyr, C. lusitaniae, and C. albicans.
“However, MDR is not restricted to C. glabrata or C. auris. Other examples include C. kefyr [57], C. lusitaniae [58], and C. albicans [59,60,61].”
From Evolutionary Emergence of Drug Resistance in Candida Opportunistic Pathogens (2018) · cites this paper as [58]
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- Authors
- Asner, S. A., Giulieri, S., Diezi, M., Marchetti, O., & Sanglard, D.
- Affiliations
- Centre Hospitalier Universitaire Vaudois (CH)
- Venue
- Antimicrobial Agents and Chemotherapy
- Publisher
- American Society for Microbiology
- Published
- 2015-12
- Volume
- 59
- Issue
- 12
- Pages
- 7715-7722
- ISSN
- 0066-4804 (ISSN-L)
- 1098-6596
- PMC
- PMC4649199
- OpenAlex
- W2234679454
- Cited by
- 82
- References
- 48
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 9 · 2023: 9 · 2022: 6 · 2021: 8 · 2020: 4 · 2019: 11 · 2018: 9 · 2017: 13 · 2016: 2
- FWCI
- 6.23
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Antimicrobial Agents and Chemotherapy (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- SERVAL (Université de Lausanne) (publishedVersion, other-oa)
- IRIS (submittedVersion)
- SERVAL (Université de Lausanne) (submittedVersion)
- Funders
- Pfizer
- Astellas Pharma
- Universität Zürich
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Life Sciences › Agricultural and Biological Sciences › Ecology, Evolution, Behavior and Systematics › Fungal Plant Pathogen Control
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Fungal and yeast genetics research
- Keywords
- Candida lusitaniae, echinocandin resistance, caspofungin resistance, fluconazole resistance, FKS1 mutations, beta-1,3-glucan synthase, candidemia, persistent candidemia, liposomal amphotericin B, azoles, immunocompromised children
- MeSH terms
- Amino Acid Sequence, Antifungal Agents, Candida, Candidiasis, DNA, Fungal, Female, Galactose, Humans, Infant, Mannans, Microbial Sensitivity Tests, Molecular Sequence Data, Mutation, Polymorphism, Restriction Fragment Length, Leukemia, Myeloid, Acute, Immunocompromised Host, Drug Monitoring, Drug Resistance, Multiple, Fungal, beta-Glucans
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