Epidemiology of Echinocandin Resistance in Candida
Echinocandins are the newest antifungal agents approved for use in treating Candida infections in the USA. They act by interfering with 1,3-β-d-glucan synthase and therefore disrupt cell wall production and lead to Candida cell death. There is no intrinsic resistance to echinocandins among Candida species, and isolates from historic collections archived before the release of the echinocandins show no resistance. Resistance to the echinocandins remains low among most Candida species and ranges overall from 0 to 1 %. Among isolates of Candida glabrata, the proportion of resistant isolates is higher and has been reported to be as high as 13.5 % in at least one hospital. Antifungal resistance is due to specific amino acid mutations in the Fksp subunit(s) of the 1,3-β-d-glucan synthase which are localized to one of two hot spots. These mutations are being recognized in isolates from patients who have failed echinocandin therapy and often lead to a poor outcome. While the future looks bright for the echinocandins against most Candida species, C. glabrata remains a species of concern and resistance rates of C. glabrata to the echinocandins should be monitored closely.
KeywordsEchinocandin Antifungal Candida Micafungin Anidulafungin Caspofungin Epidemiology
The findings and conclusions of this article are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.
Compliance with Ethics Guidelines
Conflict of Interest
NT Grossman, TM Chiller, and SR Lockhart all declare no conflicts of interest.
Human and Animal Rights and Informed Consent
All studies by the authors involving animal and/or human subjects were performed after approval by the appropriate institutional review boards. When required, written informed consent was obtained from all participants.
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