Amphotericin B Induction with Voriconazole Consolidation as Salvage Therapy for FKS-Associated Echinocandin Resistance in Candida glabrata Septic Arthritis and Osteomyelitis

Antimicrob Agents Chemother. 2019 Jul 25;63(8):e00512-19. doi: 10.1128/AAC.00512-19. Print 2019 Aug.

Abstract

We report the case of a 61-year-old female with Crohn's disease dependent on total parenteral nutrition who developed a central venous catheter bloodstream infection and septic arthritis, complicated further by osteomyelitis and persistent Candida glabrata fungemia. Fluconazole treatment led to persistent infection, and micafungin therapy failed with development of FKS-associated resistance. Infection responded after initiation of amphotericin B plus voriconazole. Echinocandin resistance is increasingly recognized, suggesting a role for alternative antifungal therapies.

Keywords: Candida glabrata; FKS mutation; echinocandin.

Publication types

  • Case Reports

MeSH terms

  • Amphotericin B / therapeutic use*
  • Antifungal Agents / therapeutic use
  • Arthritis, Infectious / drug therapy*
  • Arthritis, Infectious / microbiology
  • Candida glabrata / drug effects*
  • Candida glabrata / metabolism
  • Candidiasis / drug therapy
  • Candidiasis / microbiology
  • Drug Resistance, Fungal / drug effects*
  • Echinocandins / therapeutic use*
  • Fungal Proteins / metabolism
  • Humans
  • Middle Aged
  • Osteomyelitis / drug therapy*
  • Osteomyelitis / microbiology
  • Salvage Therapy / methods
  • Voriconazole / therapeutic use*

Substances

  • Antifungal Agents
  • Echinocandins
  • Fungal Proteins
  • Amphotericin B
  • Voriconazole