Stepwise development of a homozygous S80P substitution in Fks1p, conferring echinocandin resistance in Candida tropicalis.

Echinocandin resistance is most commonly detected after 3-4 weeks of treatment.

“It is most commonly detected after 3–4 weeks of treatment and is associated with a dismal outcome.”

Echinocandin resistance has emerged in Candida over recent years.

“Echinocandin resistance has emerged over the recent years.”

Echinocandin resistance has been found in most clinically relevant Candida species.

“It has been found in most clinically relevant Candida species, but is most common in C. glabrata with rates exceeding 10% at selected institutions.”

Acquired echinocandin resistance has been reported in single isolates belonging to most Candida species including C. albicans, C. dubliniensis, C. kefyr, C. glabrata, C. krusei, C. lusitaniae and C. tropicalis.

“Moreover, reports on acquired echinocandin resistance, defined as resistance among species that are normally susceptible, have emerged and today acquired resistance has been reported in single isolates belonging to most Candida species including C. albicans, C. dubliniensis, C. kefyr, C. glabrata, C. krusei, C. lusitaniae and C. tropicalis (9–15).”

Most reports of acquired echinocandin resistance are case reports or case series, which collectively document the potential of resistance development in almost all species that are not intrinsically susceptible.

“Most are case reports or case series, which collectively document the potential of resistance development in almost all species that are not intrinsically susceptible (9–15).”

Although some cases are reported after short-term use (a week), most cases are diagnosed after 3-4 weeks of therapy or even later.

“Although some cases are reported after short-term use (a week)(13;19), most cases are diagnosed after 3–4 weeks of therapy or even later (12;20;21).”

Clinically relevant acquired echinocandin resistance in Candida has never been detected in the absence of FKS hot spot mutations.

“So far, clinically relevant acquired echinocandin resistance in Candida has never been detected in absence of FKS hot spot mutations.”

Target gene sequencing has become increasingly available and appropriate primers have been designed and published for the most common species.

“Target gene sequencing has become increasingly available and appropriate primers designed and published for the most common species (9–15).”

Echinocandin resistance often develops in a progressive manner.

“Echinocandin resistance often develop in a progressive manner.”

Resistant isolates can be detected in the oral flora post-candidaemia treatment at a rate of approximately 10%, often in co-existence with susceptible isolates, but are detected at a lower rate and apparently typically later (3-4 weeks) among blood isolates.

“Resistant isolates can be detected in the oral flora post candidaemia treatment at a rate of approx. 10% often in co-existence with susceptible isolates but is detected at a lower rate and apparently typically later (3–4 weeks) among blood isolates (12;21;24).”