Caspofungin
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Candida kefyr fungaemia treatment failure: case report A 61-year-old woman with Candida kefyr fungaemia died after treatment with caspofungin failed. The woman had been admitted to hospital for acute myeloid leukaemia. A blood culture sampled at day 1 during chemotherapy-induced aplasia returned a positive result for yeast; on day 3 she received caspofungin 70mg, followed thereafter by 50 mg/day [route not stated]. Subsequent analysis identified the strain Candida kefyr. A minimum inhibitory concentration (MIC) of 0.06 µg/mL was determined for caspofungin. The woman’s condition did not improve, and her treatment was switched to fluconazole on day 10. C. kefyr was identified from a blood culture, with an MIC for caspofungin of 2 µg/mL. Her treatment was later switched to voriconazole, after a blood culture on day 19 was positive for C. krusei. She died on day 30. Given the suggestion of microbiological resistance as well as clinical therapeutic failure, the woman’s case was investigated further; a mutation in the FKS gene sequence of the C. kefyr isolate was identified. Author comment: "We report here what is to our knowledge the first detection of echinocandin resistance in a clinical C. kefyr isolate that led to treatment failure." Fekkar A, et al. Rapid emergence of echinocandin resistance during Candida kefyr fungemia treatment with caspofungin. Antimicrobial Agents and Chemotherapy 57: 2380-2382, No. 5, May 2013. Available from: URL: http://dx.doi.org/10.1128/ 803096668 AAC.02037-12 - France
0114-9954/13/1481-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved
Reactions 7 Dec 2013 No. 1481
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