Anidulafungin/caspofungin

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Anidulafungin/caspofungin Drug resistance: 4 case reports

In a retrospective study of 9 patients, who were found to have Candida albicans or Candida glabrata infections in Switzerland between 2004 and 2019, 4 patients (2 men and 2 women) aged 25–85 years were described, who acquired resistance to anidulafungin or caspofungin during treatment for candidaemia [dosages, routes and durations of treatments to reactions onsets not stated]. The gene sequences of all the Candida isolates of this study have been deposited at the National Center for Biotechnology Information (NCBI) under Accession Numbers MT396587 to MT396628. A 78-year-old man (case 1 from Table 2 of the article): The man, who had prostatic cancer, underwent a urinary tract surgery [due to unspecified reason]. In 2014, he was diagnosed with Candida albicans infection (candidaemia). The antifungal susceptibility test was found to be resistant to anidulafungin, micafungin and caspofungin. Additionally, the FKS hotspot gene sequencing showed acquired mutations in regions of the FKS1 gene HS1 S645P. On anamnesis, it was noted that he previously had an episode of Candida albicans infection (candidaemia), which was found to be susceptible to anidulafungin, micafungin and caspofungin. At that time (i.e. 20 days prior), he had received caspofungin. Based on the presentation, it was determined that he acquired resistance to the antifungal agents due to and the acquired FKS mutations, and the prior exposure to caspofungin was considered to be a risk factor for development of the antifungal resistance. Thereafter, he was treated with fluconazole for 17 days and underwent an unspecified surgery with catheter removal. Unfortunately, he died on day 23. A partial role of candidaemia was determined in his death. A 84-year-old man (case 7 from Table 2 of the article): The man had a past history of gallbladder surgery [due to unspecified reason]. In 2019, he was diagnosed with Candida glabrata infection (candidaemia). The antifungal susceptibility test was found to be resistant to anidulafungin, micafungin and caspofungin. Additionally, the FKS hotspot gene sequencing showed acquired mutations in regions of the FKS2 gene HS1 S663P. On anamnesis, it was noted that he previously had an episode of Candida glabrata infection (candidaemia), which was found to be susceptible to anidulafungin, micafungin and caspofungin. At that time (i.e. 18 days prior), he had received caspofungin. Based on the presentation, it was determined that he acquired resistance to the antifungal agents due to and the acquired FKS mutations, and the prior exposure to caspofungin was considered to be a risk factor for development of the antifungal resistance. Thereafter, he was treated with caspofungin for 7 days and then with liposomal amphotericin-B for 16 days, followed by fluconazole for 20 days, which resulted in resolution of candidaemia. A 52-year-old woman (case 8 from Table 2 of the article): The woman who had secondary peritonitis, underwent an abdominal surgery. In 2019, she was diagnosed

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