Echinocandin resistance among Candida isolates at an academic medical centre 2005–15: analysis of trends and outcomes
Open accessAbstract
Objectives: To identify the frequency of micafungin resistance among clinically significant isolates of Candida stored at our institution from 2005 to 2015. Chart review of patients with resistant isolates then informed the clinical setting and outcomes associated with these infections. Methods: Clinical Candida isolates had been stored at -80°C in Brucella broth with 20% glycerol from 2005. Isolates were tested using broth microdilution to determine micafungin MICs. All Candida glabrata isolates and all isolates demonstrating decreased susceptibility to micafungin were screened for FKS mutations using a Luminex assay. Results: In total, 3876 Candida isolates were tested for micafungin resistance, including 832 C. glabrata isolates. Of those, 33 isolates from 31 patients were found to have either decreased susceptibility to micafungin and/or an FKS mutation. C. glabrata accounted for the majority of these isolates. While bloodstream infections were found to have a very high mortality rate, isolates from other sites were uncommonly associated with 30-day mortality. Overall resistance rates were very low. Conclusions: Echinocandin resistance in C. glabrata has been increasingly reported but rates at our institution remain very low. We hypothesize that a focus on antifungal stewardship may have led to these observations. Knowledge of local resistance patterns is key to appropriate empirical treatment strategies.
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One recent survey from a large academic medical center tested more than 800 C. glabrata isolates over a 10-year period and detected fewer than 3% echinocandin resistant isolates in any given year, and observed no trend towards emerging resistance.
“For instance, one recent survey from a large academic medical center tested >800 C. glabrata isolates over a 10-year period and detected fewer than 3% echinocandin resistant isolates in any given year, and observed no trend towards emerging resistance.114”
From Epidemiology of Invasive Candidiasis (2024) · cites this paper as [114]
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Epidemiology of Invasive Candidiasis
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“114 Taken as a whole, there has been a slow but steady increase in resistance rates to both fluconazole and the echinocandins over the last two decades and continued assessment of this ongoing problem is essential.”
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- Authors
- McCarty, T. P., Lockhart, S. R., Moser, S. A., Whiddon, J., Zurko, J., Pham, C. D., & Pappas, P. G.
- Affiliations
- University of Alabama at Birmingham (US)
- Centers for Disease Control and Prevention (US)
- Corresponding author
- Pappas, Peter G
- Venue
- Journal of Antimicrobial Chemotherapy
- Publisher
- Oxford University Press (OUP)
- Published
- 2018-02-28
- Volume
- 73
- Issue
- 6
- Pages
- 1677-1680
- ISSN
- 0305-7453 (ISSN-L)
- 1460-2091
- PMC
- PMC11963700
- OpenAlex
- W2789609115
- Cited by
- 21
- References
- 17
- Citations by year
- 2025: 1 · 2024: 3 · 2023: 3 · 2022: 3 · 2021: 3 · 2020: 5 · 2019: 2 · 2018: 1
- FWCI
- 2.08
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Antimicrobial Chemotherapy (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Astellas Pharma US
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Life Sciences › Agricultural and Biological Sciences › Ecology, Evolution, Behavior and Systematics › Fungal Plant Pathogen Control
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Medicine › Antibiotic Resistance in Bacteria
- Keywords
- echinocandin resistance, micafungin, Candida glabrata, Candida, bloodstream candidiasis, 30-day mortality, antifungal stewardship, empirical antifungal therapy, resistance monitoring
- MeSH terms
- Academic Medical Centers, Caspofungin, Micafungin, Adult, Antifungal Agents, Candida, Candidiasis, Female, Fungal Proteins, Humans, Male, Microbial Sensitivity Tests, Mutation, Drug Resistance, Fungal, Candida glabrata, Echinocandins, Candidemia
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