Emerging echinocandin-resistant Candida albicans and glabrata in Switzerland
- PDF / 802,889 Bytes
- 6 Pages / 595.276 x 790.866 pts Page_size
- 67 Downloads / 211 Views
BRIEF REPORT
Emerging echinocandin‑resistant Candida albicans and glabrata in Switzerland A. T. Coste1 · A. Kritikos2 · J. Li1,2 · N. Khanna3 · D. Goldenberger4 · C. Garzoni5 · C. Zehnder6 · K. Boggian7 · D. Neofytos8 · A. Riat9 · D. Bachmann1 · D. Sanglard1 · F. Lamoth1,2 on behalf of The Fungal Infection Network of Switzerland (FUNGINOS) Received: 22 May 2020 / Accepted: 28 June 2020 © The Author(s) 2020
Abstract Echinocandins represent the first-line therapy of candidemia. Echinocandin resistance among Candida spp. is mainly due to acquired FKS mutations. In this study, we report the emergence of FKS-mutant Candida albicans/glabrata in Switzerland and provide the microbiological and clinical characteristics of 9 candidemic episodes. All patients were previously exposed to echinocandins (median 26 days; range 15–77). Five patients received initial echinocandin therapy with persistent candidemia in 4 of them. Overall mortality was 33%.
Introduction The pathogenic yeasts Candida spp. are an important cause of nosocomial bloodstream infections, which are associated with high mortality rates [1]. Candida albicans represents the most frequent cause of candidemia, but a progressive epidemiological shift towards more resistant non-albicans Candida spp. (e.g., Candida glabrata) is reported all over the world [1]. In this context, echinocandins (e.g., anidulafungin, caspofungin and micafungin) have become the first-line antifungal therapy because of their better efficacy and broader antifungal spectrum against Candida spp. compared to azoles [2]. However, increased use of echinocandins has been associated with the emergence of resistance to these drugs, which affects particularly C. albicans and A. T. Coste and A. Kritikos authors equally contributed to the work * F. Lamoth [email protected] 1
2
3
Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland Service of Infectious Diseases, Centre Hospitalier Universitaire Vaudois, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland Division of Infectious Diseases and Hospital Epidemiology, University and University Hospital of Basel, Basel, Switzerland
C. glabrata [3]. Echinocandin resistance in Candida spp. results from well-defined mutations in hotspot regions of the FKS gene that encodes for the 1,3-beta-d-beta-glucan synthase, the target of echinocandins [4]. These mutations usually result in pan-echinocandin resistance and affect mainly C. glabrata (prevalence range 2–13%) and more rarely C. albicans ( 16 (R) 1 (R) > 16 (R) 16 (R) 0.25 (I) > 16 (R) 0.06 (S) > 16 (R) 0.03 (S) 16 (R)
FLC
4 (SDD) 4 (SDD) 2 (S) 16 µg/mL with caspofungin MIC being usually higher compared to anidulafungin or micafungin MICs. Echinocandin resistance among Candida spp. remains rare. Previous observations are limited to small case-series (7–25 cases) with sometimes incomplete clinical data and mainly reported from the North American continent [3, 5, 6, 8, 9]. The presen
Data Loading...
