FKS mutations were identified in 18% of 72 patients with C. glabrata candidemia. Common risk factors for FKS mutant isolates included previous echinocandin exposure, which also influenced response rates.

B loodstream infections caused by Candida spp. or candidemia are the fourth most common cause of nosocomial bloodstream infections in the US. 1 Candidemia is associated with mortality rates approaching 50% and health care costs exceeding $40,000 per incident. 1-3 C. albicans is the most commonly isolated species; however, the incidence of non-C. albicans spp. has increased over the past 2 decades. 4,5 Non-C. albicans spp., including C. glabrata and C. krusei, are associated with higher rates of antifungal resistance to traditional first-line antifungal agents such as fluconazole and possibly reduced susceptibility to amphotericin B. The echinocandins have good in vitro activity against most non-C. albicans spp. and are recommended as first-line agents for the treatment of candidemia. 6 Despite nearly a decade of extensive echinocandin use, the incidence of echinocandin resistance in Candida spp. remains low; however, reports of clinical failure and isolation of resistant isolates are becoming more frequent (Table 1). 7-23 Recently published surveillance studies have shown an incidence of echinocandin resistance of 2.9-3.1% among all Candida spp. 24,25 However, current breakpoints may be set too high to identify all mutant isolates. 26-28

No abstract