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Echinocandin resistance: an emerging clinical problem?

Arendrup, Maiken C.a; Perlin, David S.b

Current Opinion in Infectious Diseases: December 2014 - Volume 27 - Issue 6 - p 484–492
doi: 10.1097/QCO.0000000000000111
ANTIMICROBIALS: Edited by Monica A. Slavin and William Irving
Editor's Choice

Purpose of review Echinocandin resistance in Candida is a great concern, as the echinocandin drugs are recommended as first-line therapy for patients with invasive candidiasis. Here, we review recent advances in our understanding of the epidemiology, underlying mechanisms, methods for detection and clinical implications.

Recent findings Echinocandin resistance has emerged over the recent years. It has been found in most clinically relevant Candida spp., but is most common in C. glabrata with rates exceeding 10% at selected institutions. It is most commonly detected after 3–4 weeks of treatment and is associated with a dismal outcome. An extensive list of mutations in hot spot regions of the genes encoding the target has been characterized and associated with species and drug-specific loss of susceptibility. The updated antifungal susceptibility testing reference methods identify echinocandin-resistant isolates reliably, although the performance of commercial tests is somewhat more variable. Alternative technologies are being developed, including molecular detection and matrix-assisted laser desorption ionization–time of flight.

Summary Echinocandin resistance is increasingly encountered and its occurrence makes susceptibility testing essential, particularly in patients with prior exposure. The further development of rapid and user-friendly commercially available susceptibility platforms is warranted. Antifungal stewardship is important in order to minimize unnecessary selection pressure.

aUnit of Mycology, Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark

bPublic Health Research Institute, Rutgers-New Jersey Medical School, New Jersey, USA

Correspondence to Professor Maiken C. Arendrup, MD, PhD, Dr Med. Sci, Head of Unit, Unit of Mycology (43/317), Department of Microbiology and Infection Control, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark. Tel: +45 3268 3223; e-mail: maca@ssi.dk

© 2014 Lippincott Williams & Wilkins, Inc.