Case Report: Echinocandin-Resistance Candida glabrata FKS Mutants From Patient Following Radical Cystoprostatectomy Due to Muscle-Invasive Bladder Cancer

Abstract

Invasive <i>Candida glabrata</i> infections are not common complications after radical cystoprostatectomy. Furthermore, resistance to echinocandins arising during the course of a patient's treatment is rarely recognised. We described a case of development of echinocandin resistance in a patient with muscle-invasive bladder cancer (pT2b N0 M0, high grade) diagnosis, subjected to radical cystoprostatectomy and exposed to echinocandins. A male patient with a previous surgical history after a traffic accident, who was operated on due to bladder cancer, underwent an episode of candidemia and mixed postoperative wound and urinary tract infection caused by <i>C. glabrata</i> and extended spectrum β-lactamase (ESBL)-producing <i>Escherichia coli</i> during hospital treatment. The patient was started on caspofungin. Repeat blood cultures showed clearance of the bloodstream infection; however, infection persisted at the surgical site. Resistance to echinocandins developed within 2 months from the day of initiation of therapy with caspofungin in the <i>C. glabrata</i> strain obtained from the surgical site. The isolates sequentially obtained during the patient's treatment demonstrated resistance to echinocandins due to the mutation in hotspot 1 <i>FKS2</i>. Although resistance to echinocandins is relatively rare, it should be considered in oncological patients with increased complexity of treatment and intestinal surgery.