Azole-resistant C. blankii as a cause of fungemia. Emergence of azole-resistant Candida blankii as a cause of bloodstream infection

A case of candidemia by Candida blankii in a preterm very low birth-weight neonate is described. The yeast was repeatedly isolated from bloodstream. The isolates formed cream-colored colonies with smooth surface and entire margins. Microscopic examination of wet mounts revealed ovoid budding yeast cells with pseudohyphae. The isolates showed reduced susceptibility (MIC = 12-16 µg/ml) to fluconazole by Etest. Species-specific identification was achieved by PCR-sequencing of rDNA. The presence of C. blankii DNA was also detected directly in a blood sample. Despite combination antifungal treatment with amphotericin B and caspofungin for 5 days, the patient expired.