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We report characteristics of isolates of\n                    <jats:italic>Candida albicans<\/jats:italic>\n                    and\n                    <jats:italic>Aspergillus fumigatus<\/jats:italic>\n                    detected in a patient with breakthrough infection complicating severe gastrointestinal surgery and evaluate the capability of susceptibility methods to identify candin resistance. The susceptibility of\n                    <jats:italic>C. albicans<\/jats:italic>\n                    to caspofungin and anidulafungin was investigated by Etest, microdilution (European Committee on Antibiotic Susceptibility Testing [EUCAST] and CLSI), disk diffusion, agar dilution, and\n                    <jats:italic>FKS1<\/jats:italic>\n                    sequencing and in a mouse model. Tissue was examined by immunohistochemistry, PCR, and sequencing for the presence of\n                    <jats:italic>A. fumigatus<\/jats:italic>\n                    and resistance mutations. The MICs for the\n                    <jats:italic>C. albicans<\/jats:italic>\n                    isolate were as follows: &gt;32 \u03bcg\/ml caspofungin and 0.5 \u03bcg\/ml anidulafungin by Etest, 2 \u03bcg\/ml caspofungin and 0.125 \u03bcg\/ml anidulafungin by EUCAST methods, and 1 \u03bcg\/ml caspofungin and 0.5 \u03bcg\/ml anidulafungin by CLSI methods. Sequencing of the\n                    <jats:italic>FKS1<\/jats:italic>\n                    gene revealed a mutation leading to an S645P substitution. Caspofungin and anidulafungin failed to reduce kidney CFU counts in animals inoculated with this isolate (\n                    <jats:italic>P<\/jats:italic>\n                    &gt; 0.05 compared to untreated control animals), while both candins completely sterilized the kidneys in animals infected with a control isolate. Disk diffusion and agar dilution methods clearly separated the two isolates. Immunohistochemistry and sequencing confirmed the presence of\n                    <jats:italic>A. fumigatus<\/jats:italic>\n                    without\n                    <jats:italic>FSK1<\/jats:italic>\n                    resistance mutations in liver and lung tissues. Breakthrough disseminated aspergillosis and candidiasis developed despite an absence of characteristic\n                    <jats:italic>FKS1<\/jats:italic>\n                    resistance mutations in the\n                    <jats:italic>Aspergillus<\/jats:italic>\n                    isolates. EUCAST and CLSI methodology did not separate the candin-resistant clinical isolate from the sensitive control isolate as well as did the Etest and agar methods.\n                  <\/jats:p>","DOI":"10.1128\/aac.01292-08","type":"journal-article","created":{"date-parts":[[2008,12,22]],"date-time":"2008-12-22T21:09:06Z","timestamp":1229980146000},"page":"1185-1193","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":111,"title":["Breakthrough\n                    <i>Aspergillus fumigatus<\/i>\n                    and\n                    <i>Candida albicans<\/i>\n                    Double Infection during Caspofungin Treatment: Laboratory Characteristics and Implication for Susceptibility Testing"],"prefix":"10.1128","volume":"53","author":[{"given":"Maiken Cavling","family":"Arendrup","sequence":"first","affiliation":[{"name":"Unit of Mycology and Parasitology, Statens Serum Institut, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillermo","family":"Garcia-Effron","sequence":"additional","affiliation":[{"name":"Public Health Research Institute, New Jersey Medical School, UMDNJ, Newark, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter","family":"Buzina","sequence":"additional","affiliation":[{"name":"Institute of Hygiene, Microbiology, and Environmental Medicine, Medical University Graz, Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus Leth","family":"Mortensen","sequence":"additional","affiliation":[{"name":"Unit of Mycology and Parasitology, Statens Serum Institut, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nanna","family":"Reiter","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Roskilde Hospital, Roskilde, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Lundin","sequence":"additional","affiliation":[{"name":"Unit of Mycology and Parasitology, Statens Serum Institut, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrik Elvang","family":"Jensen","sequence":"additional","affiliation":[{"name":"Department of Disease Biology, Faculty of Life Sciences, University of Copenhagen, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornelia","family":"Lass-Flo\u0308rl","sequence":"additional","affiliation":[{"name":"Department of Hygiene and Medical Microbiology, Innsbruck Medical University, Innsbruck, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David S.","family":"Perlin","sequence":"additional","affiliation":[{"name":"Public Health Research Institute, New Jersey Medical School, UMDNJ, Newark, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brita","family":"Bruun","sequence":"additional","affiliation":[{"name":"Department of Clinical Microbiology, Hiller\u00f8d Hospital, Hiller\u00f8d, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00942-07"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.01840-06"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-0691.2008.01954.x"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00190-08"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkm095"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.40.10.3841-3844.2002"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-0691.2007.01790.x"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1469-0691.2003.00592.x"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000298158.12101.41"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00088-08"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00053-08"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00294-005-0008-3"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01162-08"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0163-4453(96)92700-0"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.48.4.1382-1383.2004"},{"key":"e_1_3_2_17_2","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/S0021-9975(08)80271-X","volume":"110","year":"1994","unstructured":"Jensen, H. 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