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Breakthrough invasive candidiasis in patients on micafungin.

Publication ,  Journal Article
Pfeiffer, CD; Garcia-Effron, G; Zaas, AK; Perfect, JR; Perlin, DS; Alexander, BD
Published in: J Clin Microbiol
July 2010

For Candida species, a bimodal wild-type MIC distribution for echinocandins exists, but resistance to echinocandins is rare. We characterized isolates from patients with invasive candidiasis (IC) breaking through >or=3 doses of micafungin therapy during the first 28 months of its use at our center: MICs were determined and hot-spot regions within FKS genes were sequenced. Eleven of 12 breakthrough IC cases identified were in transplant recipients. The median duration of micafungin exposure prior to breakthrough was 33 days (range, 5 to 165). Seventeen breakthrough isolates were recovered: FKS hot-spot mutations were found in 5 C. glabrata and 2 C. tropicalis isolates; of these, 5 (including all C. glabrata isolates) had micafungin MICs of >2 microg/ml, but all demonstrated caspofungin MICs of >2 microg/ml. Five C. parapsilosis isolates had wild-type FKS sequences and caspofungin MICs of 0.5 to 1 microg/ml, but 4/5 had micafungin MICs of >2 microg/ml. The remaining isolates retained echinocandin MICs of 2 microg/ml and clinical breakthrough or an alternative mechanism contributes to the nonsusceptible echinocandin MICs in C. parapsilosis requires further study.

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Published In

J Clin Microbiol

DOI

EISSN

1098-660X

Publication Date

July 2010

Volume

48

Issue

7

Start / End Page

2373 / 2380

Location

United States

Related Subject Headings

  • Middle Aged
  • Microbiology
  • Microbial Sensitivity Tests
  • Micafungin
  • Male
  • Lipopeptides
  • Humans
  • Glucosyltransferases
  • Fungal Proteins
  • Female
 

Citation

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Pfeiffer, C. D., Garcia-Effron, G., Zaas, A. K., Perfect, J. R., Perlin, D. S., & Alexander, B. D. (2010). Breakthrough invasive candidiasis in patients on micafungin. J Clin Microbiol, 48(7), 2373–2380. https://doi.org/10.1128/JCM.02390-09
Pfeiffer, Christopher D., Guillermo Garcia-Effron, Aimee K. Zaas, John R. Perfect, David S. Perlin, and Barbara D. Alexander. “Breakthrough invasive candidiasis in patients on micafungin.J Clin Microbiol 48, no. 7 (July 2010): 2373–80. https://doi.org/10.1128/JCM.02390-09.
Pfeiffer CD, Garcia-Effron G, Zaas AK, Perfect JR, Perlin DS, Alexander BD. Breakthrough invasive candidiasis in patients on micafungin. J Clin Microbiol. 2010 Jul;48(7):2373–80.
Pfeiffer, Christopher D., et al. “Breakthrough invasive candidiasis in patients on micafungin.J Clin Microbiol, vol. 48, no. 7, July 2010, pp. 2373–80. Pubmed, doi:10.1128/JCM.02390-09.
Pfeiffer CD, Garcia-Effron G, Zaas AK, Perfect JR, Perlin DS, Alexander BD. Breakthrough invasive candidiasis in patients on micafungin. J Clin Microbiol. 2010 Jul;48(7):2373–2380.

Published In

J Clin Microbiol

DOI

EISSN

1098-660X

Publication Date

July 2010

Volume

48

Issue

7

Start / End Page

2373 / 2380

Location

United States

Related Subject Headings

  • Middle Aged
  • Microbiology
  • Microbial Sensitivity Tests
  • Micafungin
  • Male
  • Lipopeptides
  • Humans
  • Glucosyltransferases
  • Fungal Proteins
  • Female