Cited by 39Antifungal resistance and susceptibilityYeasts and Rust Fungi StudiesFungal Plant Pathogen Control

Fatal Breakthrough Candidemia in an Immunocompromised Patient in Kuwait Due to Candida auris Exhibiting Reduced Susceptibility to Echinocandins and Carrying a Novel Mutation in Hotspot-1 of FKS1

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Al-Obaid, Inaam, Asadzadeh, Mohammad, Ahmad, Suhail, Alobaid, Khaled, Alfouzan, Wadha, Bafna, Ritu, Emara, Maha, Joseph, Leena·2022·Journal of Fungi

Abstract

Candida auris is an emerging yeast pathogen that has recently caused major outbreaks in healthcare facilities worldwide. Clinical C. auris isolates are usually resistant to fluconazole and readily develop resistance to echinocandins and amphotericin B (AMB) during treatment. We describe here an interesting case of C. auris infection in an immunocompromised patient who had previously received AMB and caspofungin treatment. Subsequently, C. auris was isolated from tracheal (tracheostomy) secretions and twice from urine and all three isolates were susceptible to AMB and micafungin. The patient received a combination therapy with AMB and caspofungin. Although the C. auris was cleared from the urine, the patient subsequently developed breakthrough candidemia and the bloodstream isolate exhibited a reduced susceptibility to micafungin and also showed the presence of a novel (S639T) mutation in hotspot-1 of FKS1. Interestingly, C. auris from the tracheal (tracheostomy) secretions recovered one and four days later exhibited a reduced susceptibility to micafungin and S639Y and S639T mutations in hotspot-1 of FKS1, respectively. Although the treatment was changed to voriconazole, the patient expired. Our case highlights a novel FKS1 mutation and the problems clinicians are facing to treat invasive C. auris infections due to inherent or developing resistance to multiple antifungal drugs and limited antifungal armamentarium.

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Authors
Al-Obaid, I., Asadzadeh, M., Ahmad, S., Alobaid, K., Alfouzan, W., Bafna, R., Emara, M., & Joseph, L.
Affiliations
  • Department of Microbiology, Al-Sabah Hospital, Shuwaikh 70031, Kuwait
  • Kuwait University (KW)
  • Mubarak Al Kabeer Hospital (KW)
  • Al-Sabah Hospital (KW)
Corresponding author
Ahmad, Suhail
Venue
Journal of Fungi
Publisher
MDPI AG
Published
2022-03-06
Volume
8
Issue
3
Pages
267
ISSN
2309-608X (ISSN-L)
OpenAlex
W4221094564
Cited by
39
References
54
Citations by year
2026: 8 · 2025: 8 · 2024: 7 · 2023: 14 · 2022: 2
FWCI
3.79
Type
journal article
Language
en
Open access
Locations
  • Journal of Fungi (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Yeasts and Rust Fungi Studies
  • Life Sciences › Agricultural and Biological Sciences › Ecology, Evolution, Behavior and Systematics › Fungal Plant Pathogen Control
Keywords
Candida auris, echinocandin resistance, micafungin, amphotericin B, caspofungin, voriconazole, immunocompromised patients, tracheostomy, antifungal resistance, invasive candidiasis

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