In Vivo Evolution of Candida auris Multidrug Resistance in a Patient Receiving Antifungal Treatment

Candida auris is associated with life-threatening invasive disease due to a high level of drug resistance. We present a clinical case of C. auris multidrug resistance development in a patient acquired during antifungal treatment. Five isolates were prospectively recovered from a lung transplant patient receiving antifungal therapy over a 1-year period. While isolates were initially only resistant to fluconazole, the terminal isolate became resistant to caspofungin and amphotericin B with significant increase in micafungin minimum inhibitory concentration. Sequencing of ERG11 and FKS1 genes identified mutations associated with fluconazole and echinocandin resistance in the multidrug-resistant isolate, underscoring the threat of therapy-induced development of resistance.