Amphotericin B induction with voriconazole consolidation as salvage therapy for FKS-associated echinocandin resistance in Candida glabrata septic arthritis and osteomyelitis
Date:
07/25/2019
Citation:
Wright WF, Bejou N, Shields RK, Marr K, McCarty TP, Pappas PG. 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. PMID: 31345844; PMCID: PMC6658748.
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.