Abstract
Since their introduction in the 2000s, echinocandin drugs have become widely used for the treatment and prophylaxis of invasive fungal infections and, notably, invasive candidiasis. Although cases of breakthrough candidiasis in patients receiving echinocandins have been reported, clinical failure during echinocandin treatment due to the acquisition of resistance by a normally susceptible Candida spp. isolate is considered rare. To date, no publications have been published correlating the use of echinocandins and the emergence of echinocandin resistance among Candida species. So, our goal is to report an initial analysis of echinocandin use in relation to the emergence of resistant Candida isolates. We report here a single-centre experience of the emergence of eight resistant isolates belonging to normally susceptible Candida species in six patients receiving echinocandins. We describe the context and analyse the use of echinocandins over the previous decade. For seven of these isolates, we identified FKS gene mutations involved in decreased susceptibility. Seven isolates were obtained in 2011, on the heels of a ten-fold increase in caspofungin use over the preceding decade. In contrast, in 2012, the use of echinocandins decreased in our institution by 19.5 % and, in that year, only one Candida-resistant isolate was detected, despite the stable global epidemiology of invasive candidaemia. This work underlines the necessity of improving the prescription of antifungal drugs. Improvement in the monitoring of strain susceptibility should also be considered in order to better detect the emergence of resistant or non-susceptible yeast strains.
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Acknowledgements
We thank Pfizer, Astellas and MSD for providing the anidulafungin, micafungin and caspofungin, respectively.
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None to declare.
Conflict of interest
A.F. has received funds for speaking from Merck; for consultancy from Pfizer; and for travel from Astellas, Merck and Pfizer. E.D. has received funds for speaking from Merck and Schering; for consultancy from Merck and Astellas; and for travel from Merck, Schering, Gilead and Astellas. A.D. has been a consultant or a member of the speaker’s bureau for Merck, Schering, Gilead, Pfizer and Astellas. All other authors have no conflicts to declare.
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Fekkar, A., Dannaoui, E., Meyer, I. et al. Emergence of echinocandin-resistant Candida spp. in a hospital setting: a consequence of 10 years of increasing use of antifungal therapy?. Eur J Clin Microbiol Infect Dis 33, 1489–1496 (2014). https://doi.org/10.1007/s10096-014-2096-9
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DOI: https://doi.org/10.1007/s10096-014-2096-9