Echinocandin Resistance in Candida Species: Mechanisms of Reduced Susceptibility and Therapeutic Approaches

Beyda, Nicholas D; Lewis, Russell E; Garey, Kevin W

doi:10.1345/aph.1r020

Cited by 109Antifungal resistance and susceptibilityFungal Plant Pathogen ControlFungal and yeast genetics research

Echinocandin Resistance in Candida Species: Mechanisms of Reduced Susceptibility and Therapeutic Approaches

Beyda, Nicholas D, Lewis, Russell E, Garey, Kevin W·2012·Annals of Pharmacotherapy

DOI 10.1345/aph.1r020

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Abstract

OBJECTIVE: To summarize published data regarding mechanisms of reduced echinocandin susceptibility in Candida spp., the impact of echinocandin resistance on the fitness and virulence of Candida isolates, and current and future treatment approaches. DATA SOURCES: A search of MEDLINE databases (1966-September 2011) was conducted. STUDY SELECTION AND DATA EXTRACTION: Databases were searched using the terms echinocandin, resistance, and Candida. Citations from publications were reviewed for additional references. DATA SYNTHESIS: Echinocandins have in vitro activity against most Candida spp. and are first-line agents in the treatment of candidemia. However, case reports describing echinocandin treatment failure due to resistant isolates have been published. Reduced echinocandin susceptibility has been shown to occur via 3 main mechanisms: (1) adaptive stress responses, which result in elevated cell wall chitin content and paradoxical growth in vitro at supra minimum inhibitory concentrations (MICs); (2) acquired FKS mutations, which confer reduced glucan synthase sensitivity, elevated MICs, and are associated with clinical failure; and (3) intrinsic FKS mutations, which are naturally occurring mutations in C. parapsilosis and C. guilliermondii, which confer elevated MIC levels but a lower level of reduced glucan synthase sensitivity compared with acquired FKS mutations. Some FKS mutants have been shown to have significantly reduced fitness and virulence versus wild type isolates and may contribute to the low incidence of echinocandin resistance reported in large surveillance studies. Treatment strategies evaluated for FKS mutants include echinocandin dose escalation and combination with agents such as calcineurin inhibitors, HSP90 inhibitors, and chitin synthase inhibitors. CONCLUSIONS: While the incidence of echinocandin resistance in Candida spp. is low, it can present a significant therapeutic challenge, especially in multidrug-resistant Candida isolates. Dose escalation is unlikely to be effective in treating FKS mutant isolates, and significant adverse effects limit the clinical use of agents evaluated as combination therapy. Patients with infections failing to respond to echinocandin therapy should undergo susceptibility testing and be treated with an alternative antifungal agent if possible.

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Intrinsic FKS mutations result in elevated MIC levels but lower level of reduced β-1,3-d-glucan synthase sensitivity compared with acquired FKS mutations.
“intrinsic FKS mutations, also resulting in elevated MIC levels (but in a lower level of reduced β-1,3-d-glucan synthase sensitivity when compared with the acquired FKS mutations) [118,120,121].”
From Candida glabrata Biofilms: How Far Have We Come? (2017) · cites this paper as [118]

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ACandida albicansstrain with high MIC for caspofungin and noFKS1mutations exhibits a high chitin content and mutations in two chitinase genes
Drakulovski, P., Dunyach, C., Bertout, S., Reynes, J., & Mallié, M. (2010) · Medical Mycology · doi:10.3109/13693786.2010.538732 · Cited by 17 · see citing works
Analysis of Candida glabrata Strains with Reduced Sensitivity to Micafungin In Vitro Isolated from a Patient with Persistent Candidemia
Ishikawa, T., Takata, T., Akamatsu, S., Hatakenaka, K., Matsumoto, S., Maki, K., Ikeda, F., Tamai, R., & Tamura, K. (2010) · Japanese Journal of Infectious Diseases · doi:10.7883/yoken.63.332 · Cited by 8 · see citing works

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Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America
Pappas, P. G., Kauffman, C. A., Andes, D. R., Clancy, C. J., Marr, K. A., Ostrosky-Zeichner, L., Reboli, A. C., Schuster, M. G., Vazquez, J. A., Walsh, T. J., et al. (2016) · Clinical Infectious Diseases · doi:10.1093/cid/civ933 · Cited by 4,200 · see citing works
Pathogenesis and virulence of Candida albicans
Lopes, J. P., & Lionakis, M. S. (2021) · Virulence · doi:10.1080/21505594.2021.2019950 · Cited by 511 · see citing works
T2 Magnetic Resonance Assay for the Rapid Diagnosis of Candidemia in Whole Blood: A Clinical Trial
Mylonakis, E. E., Clancy, C. J., Ostrosky‐Zeichner, L., Garey, K. W., Alangaden, G. J., Vázquez, J. A., Groeger, J. S., Judson, M. A., Vinagre, Y.-M., Heard, S. O., et al. (2015) · Clinical Infectious Diseases · doi:10.1093/cid/ciu959 · Cited by 446 · see citing works
Antifungal drug resistance among Candida species: mechanisms and clinical impact
Sanguinetti, M., Posteraro, B., & Lass‐Flörl, C. (2015) · Mycoses · doi:10.1111/myc.12330 · Cited by 394 · see citing works
An Update on Candida tropicalis Based on Basic and Clinical Approaches
Zuza-Alves, D. L., Rocha, W. P. D. S., & Chaves, G. M. (2017) · Frontiers in Microbiology · doi:10.3389/fmicb.2017.01927 · Cited by 305 · see citing works
Invasive Candidiasis
McCarty, T. P., & Pappas, P. G. (2016) · Infectious Disease Clinics of North America · doi:10.1016/j.idc.2015.10.013 · Cited by 285 · see citing works
Antifungal Peptides as Therapeutic Agents
de Ullivarri, M. F., Arbulu, S., García-Gutiérrez, E., & Cotter, P. D. (2020) · Frontiers in Cellular and Infection Microbiology · doi:10.3389/fcimb.2020.00105 · Cited by 270 · see citing works
Candidemia and Invasive Candidiasis
McCarty, T. P., White, C. M., & Pappas, P. G. (2021) · Infectious Disease Clinics of North America · doi:10.1016/j.idc.2021.03.007 · Cited by 260 · see citing works
Clinical hepatotoxicity associated with antifungal agents
Kyriakidis, I., Tragiannidis, A., Munchen, S., & Groll, A. H. (2016) · Expert Opinion on Drug Safety · doi:10.1080/14740338.2017.1270264 · Cited by 189 · see citing works
Anti-Candida albicans natural products, sources of new antifungal drugs: A review
Zida, A., Bamba, S., Yacouba, A., Ouedraogo-Traoré, R., & Guiguemdé, R. T. (2016) · Journal de Mycologie Médicale · doi:10.1016/j.mycmed.2016.10.002 · Cited by 182 · see citing works
FKS Mutant Candida glabrata: Risk Factors and Outcomes in Patients With Candidemia
Beyda, N. D., John, J., Kilic, A., Alam, M. J., Lasco, T. M., & Garey, K. W. (2014) · Clinical Infectious Diseases · doi:10.1093/cid/ciu407 · Cited by 174 · see citing works
Antifungal lock therapy
Walraven, C. J., & Lee, S. A. (2013) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.01351-12 · Cited by 132 · see citing works
Candida glabrata Biofilms: How Far Have We Come?
Rodrigues, C., Rodrigues, M., Silva, S., & Henriques, M. (2017) · Journal of Fungi · doi:10.3390/jof3010011 · Cited by 129 · see citing works
Candida parapsilosis Virulence and Antifungal Resistance Mechanisms: A Comprehensive Review of Key Determinants
Branco, J., Miranda, I. M., & Rodrigues, A. G. (2023) · Journal of Fungi · doi:10.3390/jof9010080 · Cited by 133 · see citing works
Current status of antifungal resistance and its impact on clinical practice
Alcázar‐Fuoli, L., & Mellado, E. (2014) · British Journal of Haematology · doi:10.1111/bjh.12896 · Cited by 118 · see citing works
Multicenter Study Evaluating the Vitek MS System for Identification of Medically Important Yeasts
Westblade, L. F., Jennemann, R., Branda, J. A., Bythrow, M., Ferraro, M. J., Garner, O. B., Ginocchio, C. C., Lewinski, M. A., Manji, R., Mochon, A. B., et al. (2013) · Journal of Clinical Microbiology · doi:10.1128/jcm.00680-13 · Cited by 103 · see citing works
Rezafungin (CD101), a next-generation echinocandin: A systematic literature review and assessment of possible place in therapy
Sofjan, A. K., Mitchell, A. C., Shah, D. N., Nguyen, T. H., Sim, M., Trojcak, A., Beyda, N. D., & Garey, K. W. (2018) · Journal of Global Antimicrobial Resistance · doi:10.1016/j.jgar.2018.02.013 · Cited by 99 · see citing works
Antifungal drug resistance mechanisms in pathogenic fungi: from bench to bedside
Cuenca‐Estrella, M. (2013) · Clinical Microbiology and Infection · doi:10.1111/1469-0691.12495 · Cited by 97 · see citing works
Overview on the Infections Related to Rare Candida Species
Kumar, S., Kumar, A., Roudbary, M., Mohammadi, R., Černáková, L., & Rodrigues, C. F. (2022) · Pathogens · doi:10.3390/pathogens11090963 · Cited by 97 · see citing works
Tolerance to Caspofungin in Candida albicans Is Associated with at Least Three Distinctive Mechanisms That Govern Expression of FKS Genes and Cell Wall Remodeling
Yang, F., Zhang, L., Wakabayashi, H., Myers, J., Jiang, Y., Cao, Y., Jimenez-Ortigosa, C., Perlin, D. S., & Rustchenko, E. (2017) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.00071-17 · Cited by 81 · see citing works
Randomized Trial of Micafungin for the Prevention of Invasive Fungal Infection in High-Risk Liver Transplant Recipients
Saliba, F., Pascher, A., Cointault, O., Laterre, P.-F., Cervera, C., Waele, J. J. D., Cillo, U., Langer, R. M., Lugano, M., Göran-Ericzon, B., et al. (2014) · Clinical Infectious Diseases · doi:10.1093/cid/ciu1128 · Cited by 82 · see citing works
Antifungal drug resistance in Candida species
Morace, G., Perdoni, F., & Borghi, E. (2014) · Journal of Global Antimicrobial Resistance · doi:10.1016/j.jgar.2014.09.002 · Cited by 80 · see citing works
Antifungal Application of Nonantifungal Drugs
Stylianou, M., Kulesskiy, E., Lopes, J. P., Granlund, M., Wennerberg, K., & Urban, C. F. (2013) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.01087-13 · Cited by 71 · see citing works
Activity of a Long-Acting Echinocandin, Rezafungin, and Comparator Antifungal Agents Tested against Contemporary Invasive Fungal Isolates (SENTRY Program, 2016 to 2018)
Pfaller, M. A., Carvalhaes, C., Messer, S. A., Rhomberg, P. R., & Castanheira, M. (2020) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.00099-20 · Cited by 68 · see citing works
Rapid Development of Candida krusei Echinocandin Resistance during Caspofungin Therapy
Forastiero, A., Garcia-Gil, V., Rivero-Menéndez, O., Garcia‐Rubio, R., Monteiro, M. C., Alastruey‐Izquierdo, A., Jordán, R., Agorio, I., & Mellado, E. (2015) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.01005-15 · Cited by 68 · see citing works
Microbial Biotransformation to Obtain New Antifungals
Bianchini, L. F., Arruda, M. F. C., Vieira, S., Campelo, P. M. S., Grégio, A. M. T., & Rosa, E. A. R. (2015) · Frontiers in Microbiology · doi:10.3389/fmicb.2015.01433 · Cited by 65 · see citing works
Antifungal drug resistance in Candida: a special emphasis on amphotericin B
Ahmady, L., Gothwal, M., Mukkoli, M. M., & Bari, V. K. (2024) · Apmis · doi:10.1111/apm.13389 · Cited by 58 · see citing works
Candidemia: incidence rates, type of species, and risk factors at a tertiary care academic hospital in China
Wu, Z., Liu, Y., Feng, X., Liu, Y., Wang, S., Zhu, X., Chen, Q., & Pan, S. (2014) · International Journal of Infectious Diseases · doi:10.1016/j.ijid.2013.11.011 · Cited by 53 · see citing works
Klebsiella pneumoniae prevents spore germination and hyphal development of Aspergillus species
Nogueira, F., Pereira, L., Jenull, S., Kuchler, K., & Lion, T. (2019) · Scientific Reports · doi:10.1038/s41598-018-36524-8 · Cited by 50 · see citing works
Antifungal Pipeline
McCarty, T. P., & Pappas, P. G. (2021) · Frontiers in Cellular and Infection Microbiology · doi:10.3389/fcimb.2021.732223 · Cited by 47 · see citing works
A Mechanosensitive Channel Governs Lipid Flippase-Mediated Echinocandin Resistance in Cryptococcus neoformans
Cao, C., Wang, Y., Husain, S., Soteropoulos, P., & Xue, C. (2019) · mBio · doi:10.1128/mbio.01952-19 · Cited by 45 · see citing works
Emerging Candida species isolated from renal transplant recipients: Species distribution and susceptibility profiles
Diba, K., Makhdoomi, K., Nasri, E., Vaezi, A., Javidnia, J., Gharabag, D. J., Jazani, N. H., Chavshin, A. R., Badiee, P., Badali, H., et al. (2018) · Microbial Pathogenesis · doi:10.1016/j.micpath.2018.09.026 · Cited by 43 · see citing works
Therapeutic Drug Monitoring of the Echinocandin Antifungal Agents: Is There a Role in Clinical Practice? A Position Statement of the Anti-Infective Drugs Committee of the International Association of Therapeutic Drug Monitoring and Clinical Toxicology
Kim, H. Y., Baldelli, S., Märtson, A., STOCKER, S. L., Alffenaar, J. C., Cattaneo, D., & Marriott, D. J. E. (2021) · Therapeutic Drug Monitoring · doi:10.1097/ftd.0000000000000931 · Cited by 39 · see citing works
Clinical Practice Patterns in Hospitalized Patients at Risk for Invasive Candidiasis
Aitken, S. L., Beyda, N. D., Shah, D. N., Palmer, H. R., Lasco, T. M., Koo, H. L., & Garey, K. W. (2014) · Annals of Pharmacotherapy · doi:10.1177/1060028014529928 · Cited by 38 · see citing works
The rise in cases of mucormycosis, candidiasis and aspergillosis amidst COVID19
Ghosh, A., Sarkar, A., Paul, P., & Patel, P. K. (2021) · Fungal Biology Reviews · doi:10.1016/j.fbr.2021.09.003 · Cited by 36 · see citing works
Anti-Candida Cassane-Type Diterpenoids from the Root Bark of Swartzia simplex
Favre-Godal, Q., Dorsaz, S., Queiroz, E. F., Marcourt, L., Ebrahimi, S. N., Allard, P., Voinesco, F., Hamburger, M. O., Gupta, M. P., Gindro, K., et al. (2015) · Journal of Natural Products · doi:10.1021/acs.jnatprod.5b00744 · Cited by 38 · see citing works
T2 Magnetic Resonance for Fungal Diagnosis
Zervou, F. N., Zacharioudakis, I. M., Kurpewski, J., & Mylonakis, E. E. (2016) · Methods in molecular biology · doi:10.1007/978-1-4939-6515-1_18 · Cited by 39 · see citing works
Biofilm-Associated Candidiasis: Pathogenesis, Prevalence, Challenges and Therapeutic Options
Amann, V., Kissmann, A., Firacative, C., & Rosenau, F. (2025) · Pharmaceuticals · doi:10.3390/ph18040460 · Cited by 41 · see citing works
Antifungal Activity of Geldanamycin Alone or in Combination with Fluconazole Against Candida species
Zhang, J., Liu, W. Y., Tan, J., Sun, Y., Wan, Z., & Li, R. (2013) · Mycopathologia · doi:10.1007/s11046-012-9612-1 · Cited by 34 · see citing works
Susceptibility to echinocandins of Candida spp. strains isolated in Italy assessed by European Committee for Antimicrobial Susceptibility Testing and Clinical Laboratory Standards Institute broth microdilution methods
Montagna, M. T., Lovero, G., Coretti, C., Martinelli, D., Giglio, O. D., Iatta, R., Balbino, S., Rosato, A., & Caggiano, G. (2015) · BMC Microbiology · doi:10.1186/s12866-015-0442-4 · Cited by 32 · see citing works
Invasive candidiasis: update on current pharmacotherapy options and future perspectives
Tragiannidis, A., Tsoulas, C., Kerl, K., & Groll, A. H. (2013) · Expert Opinion on Pharmacotherapy · doi:10.1517/14656566.2013.805204 · Cited by 33 · see citing works
Elevated Vacuolar Uptake of Fluorescently Labeled Antifungal Drug Caspofungin Predicts Echinocandin Resistance in Pathogenic Yeast
Jaber, Q. Z., Bibi, M., Księżopolska, E., Gabaldón, T., Berman, J. G., & Fridman, M. (2020) · ACS Central Science · doi:10.1021/acscentsci.0c00813 · Cited by 31 · see citing works
Clinical features of patients with infections caused by Candida guilliermondii and Candida fermentati and antifungal susceptibility of the isolates at a medical centre in Taiwan, 2001-10
Chen, Y., Huang, S., Tang, J., Tsay, W., Yao, M., Ko, B., Chou, W., Tien, H., & Hsueh, P. (2013) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dkt214 · Cited by 31 · see citing works
In Vitro Activities of Novel Azole Compounds ATTAF-1 and ATTAF-2 against Fluconazole-Susceptible and -Resistant Isolates of Candida Species
Fakhim, H., Emami, S., Vaezi, A., Hashemi, S. M., Faeli, L., Diba, K., Dannaoui, É., & Badali, H. (2016) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.01106-16 · Cited by 29 · see citing works
Portrait of Matrix Gene Expression in Candida glabrata Biofilms with Stress Induced by Different Drugs
Rodrigues, C. F., & Henriques, M. (2018) · Genes · doi:10.3390/genes9040205 · Cited by 29 · see citing works
Epidemiology of Echinocandin Resistance in Candida
Grossman, N. T., Chiller, T. M., & Lockhart, S. R. (2014) · Current Fungal Infection Reports · doi:10.1007/s12281-014-0209-7 · Cited by 28 · see citing works
The progress and future of the treatment of Candida albicans infections based on nanotechnology
Gao, Y., Cao, Q., Xiao, Y., Wu, Y., Ding, L., Huang, H., Li, Y., Yang, J., & Meng, L. (2024) · Journal of Nanobiotechnology · doi:10.1186/s12951-024-02841-6 · Cited by 27 · see citing works
Puupehenone, a Marine-Sponge-Derived Sesquiterpene Quinone, Potentiates the Antifungal Drug Caspofungin by Disrupting Hsp90 Activity and the Cell Wall Integrity Pathway
Tripathi, S., Feng, Q. F., Liu, L., Levin, D. E., Roy, K. K., Doerksen, R. J., Baerson, S. R., Shi, X., Pan, X., Xu, W., et al. (2020) · mSphere · doi:10.1128/msphere.00818-19 · Cited by 26 · see citing works
Review on fungal enzyme inhibitors – potential drug targets to manage human fungal infections
Ramakrishnan, J., Rathore, S. S., & Raman, T. (2016) · RSC Advances · doi:10.1039/c6ra01577h · Cited by 27 · see citing works
Infectious Arthritis of Native Joints
Ohl, C. A., & Forster, D. W. (2015) · Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases · doi:10.1016/b978-1-4557-4801-3.00105-3 · Cited by 25 · see citing works
NanoDisk containing super aggregated amphotericin B: a high therapeutic index antifungal formulation with enhanced potency
Oda, M. N., Burgess, B. L., Yumin, Baker, Luo, Forte, & Carroll, S. F. (2013) · International Journal of Nanomedicine · doi:10.2147/ijn.s50113 · Cited by 24 · see citing works
Assessment of caspofungin susceptibility of Candida glabrata by the Etest®, CLSI, and EUCAST methods, and detection of FKS1 and FKS2 mutations
Bourgeois, N., Laurens, C., Bertout, S., Balard, Y., Krasteva, D., Rispail, P., & Lachaud, L. (2014) · European Journal of Clinical Microbiology & Infectious Diseases · doi:10.1007/s10096-014-2069-z · Cited by 23 · see citing works
Epidemiology and risk factors for invasive fungal disease in liver transplant recipients in a tertiary transplant center
Lum, L., Lee, A., Vu, M., Strasser, S., & Davis, R. (2020) · Transplant Infectious Disease · doi:10.1111/tid.13361 · Cited by 22 · see citing works
Invasive Candidiasis
Schroeder, J. A., Wilson, C. M., & Pappas, P. G. (2024) · Infectious Disease Clinics of North America · doi:10.1016/j.idc.2024.11.007 · Cited by 24 · see citing works
Recent advances in the treatment of life-threatening, invasive fungal infections
Drew, R. H., Townsend, M. L., Pound, M. W., Johnson, S. W., & Perfect, J. R. (2013) · Expert Opinion on Pharmacotherapy · doi:10.1517/14656566.2013.838217 · Cited by 22 · see citing works
Molecular identification and antifungal susceptibility profiles of Candida parapsilosis complex species isolated from culture collection of clinical samples
Ataídes, F. S., Costa, C. R., Souza, L. K. H. E., Fernandes, O. D. F. L., Jesuíno, R. S. A., & Silva, M. D. R. R. (2015) · Revista da Sociedade Brasileira de Medicina Tropical · doi:10.1590/0037-8682-0120-2015 · Cited by 18 · see citing works
An Automated High-Throughput Cell-Based Multiplexed Flow Cytometry Assay to Identify Novel Compounds to Target Candida albicans Virulence-Related Proteins
Bernardo, S. M., Allen, C., Waller, A., Young, S. M., Oprea, T. I., Sklar, L. A., & Lee, S. A. (2014) · PLoS ONE · doi:10.1371/journal.pone.0110354 · Cited by 13 · see citing works
Antifungal Plant Defensins as an Alternative Tool to Combat Candidiasis
Finkina, E. I., Shevchenko, O. V., Fateeva, S. I., Tagaev, A. A., & Ovchinnikova, T. V. (2024) · Plants · doi:10.3390/plants13111499 · Cited by 12 · see citing works
In Vitro Investigation of the Impact of Bacterial–Fungal Interaction on Carbapenem-Resistant Klebsiella pneumoniae
Moubasher, H., El‐Kholy, A., Sherif, M. M., Zahran, M., & Elnagdy, S. M. (2022) · Molecules · doi:10.3390/molecules27082541 · Cited by 11 · see citing works
Structural characterization of fungus-specific histone deacetylase Hos3 provides insights into developing selective inhibitors with antifungal activity
Pang, N., Sun, J., Che, S., & Yang, N. (2022) · Journal of Biological Chemistry · doi:10.1016/j.jbc.2022.102068 · Cited by 11 · see citing works
Current pharmacological concepts for wise use of echinocandins in the treatment ofCandidainfections in septic critically ill patients
Pea, F. (2013) · Expert Review of Anti-infective Therapy · doi:10.1586/14787210.2013.836058 · Cited by 11 · see citing works
Identification of Molecular and Genetic Resistance Mechanisms in a Candida auris Isolate in a Tertiary Care Center in Türkiye
Şengel, B. E., Ekren, B. Y., Sayın, E., Çerikçioğlu, N., Sezerman, O. U., & Odabaşı, Z. (2023) · Mycopathologia · doi:10.1007/s11046-023-00787-1 · Cited by 12 · see citing works
Antifungal Susceptibility Data and Epidemiological Distribution of Candida spp.: An In Vitro Five-Year Evaluation at University Hospital Policlinico of Catania and a Comprehensive Literature Review
Calvo, M., Scalia, G., & Trovato, L. (2024) · Antibiotics · doi:10.3390/antibiotics13100914 · Cited by 12 · see citing works
Innate Inflammatory Response and Immunopharmacologic Activity of Micafungin, Caspofungin, and Voriconazole against Wild-Type and FKS Mutant Candida glabrata Isolates
Beyda, N. D., Liao, G., Endres, B. T., Lewis, R. E., & Garey, K. W. (2015) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.00624-15 · Cited by 10 · see citing works
Risk assessment for the spread of Candida sp. in dental chair unit waterlines using molecular techniques
Mazari, W., Boucherit‐Otmani, Z., Haci, I. A. E., Ilahi, A., & Boucherit, K. (2018) · International Dental Journal · doi:10.1111/idj.12401 · Cited by 10 · see citing works
T2Candida® to guide antifungal and lengh of treatment of candidemia in a pediatric multivisceral transplant recipient
Falces‐Romero, I., Cendejas‐Bueno, E., Laplaza-González, M., Escosa‐García, L., Schüffelmann, C., Calderón-Llopis, B., Pemán, J., de la Oliva, P., & García‐Rodríguez, J. (2018) · Medical Mycology Case Reports · doi:10.1016/j.mmcr.2018.05.006 · Cited by 10 · see citing works
Comparative evaluation of antifungal susceptibility testing methods of invasive Candida species and detection of FKS genes mutations in caspofungin intermediate and resistant isolates
ElFeky, D. S., El-Wakil, D. M., Mwafy, M. M., Atia, M. M. A., & Gohar, N. M. (2025) · BMC Infectious Diseases · doi:10.1186/s12879-024-10435-8 · Cited by 9 · see citing works
Effects of the Tobacco Defensin NaD1 Against Susceptible and Resistant Strains of Candida albicans
Shevchenko, O. V., Voropaev, A. D., Bogdanov, I. V., Ovchinnikova, T. V., & Finkina, E. I. (2024) · Pathogens · doi:10.3390/pathogens13121092 · Cited by 8 · see citing works
In vitro susceptibility of amphotericin-B, voriconazole and caspofungin against Candida guilliermondii biofilms, isolated from dentals units water pipes, under different growth phases
Mazari, W., Boucherit‐Otmani, Z., & Boucherit, K. (2014) · Journal de Mycologie Médicale · doi:10.1016/j.mycmed.2014.10.027 · Cited by 7 · see citing works
Biosynthesis and Mechanism of Action of Antifungal Peptidyl Nucleoside Natural Products
Draelos, M. M., & Yokoyama, K. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-409547-2.14680-3 · Cited by 7 · see citing works
Protective and antifungal properties of Nanodisk‐Amphotericin B over commercially available Amphotericin B
Cho, D., Hoffman, K. J., Gill, G. S., Lim, D., Skinner, D. F., Mackey, C. S., Rowe, S. M., & Woodworth, B. A. (2017) · World Journal of Otorhinolaryngology - Head and Neck Surgery · doi:10.1016/j.wjorl.2017.01.002 · Cited by 7 · see citing works
Anti-Candida Activity of New Azole Derivatives Alone and in Combination with Fluconazole
Shi, C., Liu, C., Liu, J., Wang, Y., Li, J., & Xiang, M.-J. (2015) · Mycopathologia · doi:10.1007/s11046-015-9899-9 · Cited by 6 · see citing works
Phenotypic Impact and Multivariable Assessment of Antifungal Susceptibility in Candida auris Survival Using a Galleria mellonella Model
Alvarruiz, J., Gaitán, A. C. R., Cabañero-Navalón, M. D., Pemán, J., Blanes-Hernández, R., Tejido, S. D. C., & García-Bustos, V. (2025) · Journal of Fungi · doi:10.3390/jof11060406 · Cited by 5 · see citing works
Can antibiotics affect the clinical features of patients with candidemia? The retrospective evaluation of 5 years of data in an intensive care unit
Durmuş, M., Kalkan, S., Karahan, S. G., Bıçakcıoğlu, M., Özdemir, N., GÜN, Z. Ü., & Özer, A. B. (2023) · European Journal of Hospital Pharmacy · doi:10.1136/ejhpharm-2022-003673 · Cited by 5 · see citing works
Candida albicans Genes Modulating Echinocandin Susceptibility of Caspofungin-Adapted Mutants Are Constitutively Expressed in Clinical Isolates with Intermediate or Full Resistance to Echinocandins
Yadav, A., Sah, S. K., Perlin, D. S., & Rustchenko, E. P. (2024) · Journal of Fungi · doi:10.3390/jof10030224 · Cited by 5 · see citing works
Experimental Therapy with Azoles against Candida guilliermondii
Sanchis, M., Pastor, F. J., Capilla, J., Sutton, D. A., Fothergill, A. W., & Guarro, J. (2014) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.03051-14 · Cited by 4 · see citing works
Anti-fungal peptides: an emerging category with enthralling therapeutic prospects in the treatment of candidiasis
Prusty, J. S., Kumar, A., & Kumar, A. (2024) · Critical Reviews in Microbiology · doi:10.1080/1040841x.2024.2418125 · Cited by 5 · see citing works
Are Echinocandins Better Than Azoles for Invasive Candidiasis?
Revankar, S. G., & Sobel, J. D. (2012) · Current Fungal Infection Reports · doi:10.1007/s12281-012-0124-8 · Cited by 4 · see citing works
Multidrug- and Cross-Resistant Candida: the Looming Threat
Lackner, M., Martín‐Vicente, A., & Lass‐Flörl, C. (2014) · Current Fungal Infection Reports · doi:10.1007/s12281-014-0210-1 · Cited by 4 · see citing works
In vitro interactions of crocin with fluconazole against Candida isolates
Aslani, N., Hedayati, M. T., Nabili, M., Faramarzi, A., Sadeghi, F., & Moazeni, M. (2019) · Current Medical Mycology · doi:10.18502/cmm.4.4.383 · Cited by 5 · see citing works
Opportunistic Mycoses
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New insights into the echinocandin resistance in Candida spp. in the clinical settingPreprint
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Authors: Beyda, N. D., Lewis, R. E., & Garey, K. W.
Affiliations: University of Houston (US)
ORCID: Beyda, Nicholas D
Lewis, Russell E
Garey, Kevin W
Venue: Annals of Pharmacotherapy
Publisher: SAGE Publications
Published: 2012-07
Volume: 46
Issue: 7-8
Pages: 1086-1096
ISSN: 0012-6578 (ISSN-L)
1060-0280
1542-6270
DOI: 10.1345/aph.1r020
OpenAlex: W2123330154
Cited by: 109
References: 69
Citations by year: 2026: 5 · 2025: 8 · 2024: 9 · 2023: 5 · 2022: 5 · 2021: 5 · 2020: 5 · 2019: 6 · 2018: 9 · 2017: 5 · 2016: 5 · 2015: 16 · 2014: 13 · 2013: 11 · 2012: 2
FWCI: 1.68
Type: journal article
Language: en
Open access: closed
Licence: journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations: Annals of Pharmacotherapy (publishedVersion)
PubMed (publishedVersion)
Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion)
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 Biology › Fungal and yeast genetics research
Keywords: echinocandin resistance, Candida, reduced susceptibility, glucan synthase, adaptive stress response, chitin content, candidemia, antifungal treatment failure, dose escalation, calcineurin inhibitors, Hsp90 inhibitors, chitin synthase inhibitors, virulence, Candida parapsilosis, Candida guilliermondii, multidrug resistance
MeSH terms: Antifungal Agents, Candida, Candidiasis, Glucosyltransferases, Humans, Microbial Sensitivity Tests, Mutation, Drug Resistance, Fungal, Echinocandins

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Echinocandin Resistance in Candida Species: Mechanisms of Reduced Susceptibility and Therapeutic Approaches

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