Fatal Breakthrough Candidemia in an Immunocompromised Patient in Kuwait Due to Exhibiting Reduced Susceptibility to Echinocandins and Carrying a Novel Mutation in Hotspot-1 of

is an emerging yeast pathogen that has recently caused major outbreaks in healthcare facilities worldwide. Clinical isolates are usually resistant to fluconazole and readily develop resistance to echinocandins and amphotericin B (AMB) during treatment. We describe here an interesting case of infection in an immunocompromised patient who had previously received AMB and caspofungin treatment. Subsequently, was isolated from tracheal (tracheostomy) secretions and twice from urine and all three isolates were susceptible to AMB and micafungin. The patient received a combination therapy with AMB and caspofungin. Although the was cleared from the urine, the patient subsequently developed breakthrough candidemia and the bloodstream isolate exhibited a reduced susceptibility to micafungin and also showed the presence of a novel (S639T) mutation in hotspot-1 of . Interestingly, from the tracheal (tracheostomy) secretions recovered one and four days later exhibited a reduced susceptibility to micafungin and S639Y and S639T mutations in hotspot-1 of , respectively. Although the treatment was changed to voriconazole, the patient expired. Our case highlights a novel mutation and the problems clinicians are facing to treat invasive infections due to inherent or developing resistance to multiple antifungal drugs and limited antifungal armamentarium.