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Caspofungin-resistant Candida tropicalis strains causing breakthrough fungemia in patients at high risk for

Guillermo Garcia-Effron1, Dimitrios P Kontoyiannis, Russell E Lewis

  • 1Public Health Research Institute, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey , USA.

Antimicrobial Agents and Chemotherapy
|September 17, 2008
PubMed

Insights

Candida tropicalis caused breakthrough fungemia in stem cell transplant patients despite caspofungin treatment. Mutations in the Fks1 gene were found in these resistant strains.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Hematology

Background:

  • Allogeneic stem cell transplantation (SCT) recipients are at high risk for invasive fungal infections.
  • Echinocandins, such as caspofungin, are commonly used for prophylaxis and treatment of invasive candidiasis.
  • Candida tropicalis is an opportunistic fungal pathogen that can cause severe infections in immunocompromised individuals.

Observation:

  • Three cases of breakthrough fungemia caused by Candida tropicalis were observed in allogeneic SCT recipients.
  • These patients were receiving caspofungin for prophylaxis and/or treatment.
  • The C. tropicalis isolates exhibited high minimum inhibitory concentrations (MICs) to echinocandins.

Findings:

  • Genetically distinct isolates of C. tropicalis were identified.
  • All identified strains possessed a specific mutation in the Fks1 gene.
  • This mutation resulted in an amino acid substitution within the Fks1p hot spot 1 region, conferring echinocandin resistance.

Implications:

  • The emergence of echinocandin-resistant Candida tropicalis poses a significant challenge in managing invasive fungal infections in vulnerable patient populations.
  • Genetic mutations in Fks1p are a key mechanism of caspofungin resistance in C. tropicalis.
  • This highlights the need for vigilant monitoring of antifungal resistance patterns and consideration of alternative treatment strategies in SCT recipients.

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