title: Echinocandin resistance: an emerging clinical problem?
abstract: OBJECTIVE
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.
authors.forename: Maiken C
authors.initials: MC
authors.lastname: Arendrup
authors.forename: David S
authors.initials: DS
authors.lastname: Perlin
mesh_terms: D000935:Antifungal Agents / Q000008:administration & dosage* / Q000494:pharmacology; D041221:Candida glabrata / Q000187:drug effects* / Q000235:genetics / Q000276:immunology; D002177:Candidiasis / Q000188:drug therapy* / Q000235:genetics / Q000276:immunology / Q000382:microbiology; D004252:DNA Mutational Analysis; D025141:Drug Resistance, Fungal / Q000187:drug effects* / Q000235:genetics; D054714:Echinocandins / Q000008:administration & dosage* / Q000494:pharmacology; D005656:Fungal Proteins / Q000187:drug effects*; D020022:Genetic Predisposition to Disease; D006801:Humans; D008826:Microbial Sensitivity Tests; D058990:Molecular Targeted Therapy; D009154:Mutation / Q000235:genetics; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D005656:Fungal Proteins