Szymankiewicz Maria, Kamecki Krzysztof, Jarzynka Sylwia, Koryszewska-Bagińska Anna, Olędzka Gabriela, Nowikiewicz Tomasz
Department of Microbiology, Prof. F. Łukaszczyk Oncology Centre, Bydgoszcz, Poland.
Department of Urological Oncology, Prof. F. Łukaszczyk Oncology Centre, Bydgoszcz, Poland.
Front Oncol. 2021 Dec 15;11:794235. doi: 10.3389/fonc.2021.794235. eCollection 2021.
Invasive 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 and extended spectrum β-lactamase (ESBL)-producing 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 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 . Although resistance to echinocandins is relatively rare, it should be considered in oncological patients with increased complexity of treatment and intestinal surgery.
侵袭性感染并非根治性膀胱前列腺切除术后的常见并发症。此外，在患者治疗过程中出现的对棘白菌素的耐药性很少被识别。我们描述了一例在诊断为肌层浸润性膀胱癌（pT2b N0 M0，高级别）的患者中发生棘白菌素耐药的病例，该患者接受了根治性膀胱前列腺切除术并接触了棘白菌素。一名有交通事故手术史的男性患者因膀胱癌接受手术，在住院治疗期间发生了念珠菌血症以及由产超广谱β-内酰胺酶（ESBL）的 引起的术后伤口和尿路感染混合感染。患者开始使用卡泊芬净治疗。重复血培养显示血流感染已清除；然而，手术部位的感染仍持续存在。从手术部位分离出的菌株在开始使用卡泊芬净治疗后的2个月内出现了对棘白菌素的耐药性。在患者治疗期间依次获得的分离株由于热点1突变而对棘白菌素耐药。尽管对棘白菌素的耐药性相对罕见，但在治疗复杂性增加的肿瘤患者和肠道手术患者中应予以考虑。
