Emergence of echinocandin-resistant Candida spp. in a hospital setting: a consequence of 10 years of increasing use of antifungal therapy?

Since their introduction in the 2000s, echinocandin drugs have become widely used for the treatment and prophylaxis of invasive fungal infections and, notably, invasive candidiasis. Although cases of breakthrough candidiasis in patients receiving echinocandins have been reported, clinical failure du...

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Bibliographic Details
Published in:European journal of clinical microbiology & infectious diseases 2014-09, Vol.33 (9), p.1489-1496
Main Authors: Fekkar, A., Dannaoui, E., Meyer, I., Imbert, S., Brossas, J. Y., Uzunov, M., Mellon, G., Nguyen, S., Guiller, E., Caumes, E., Leblond, V., Mazier, D., Fievet, M. H., Datry, A.
Format: Article
Language:English
Subjects:
Aged
Antibiotics. Antiinfectious agents. Antiparasitic agents
Antifungal agents
Antifungal Agents - pharmacology
Antifungal Agents - therapeutic use
Biological and medical sciences
Biomedical and Life Sciences
Biomedicine
Candida
Candida - drug effects
Candida - isolation & purification
Candidiasis - epidemiology
Candidiasis - microbiology
Disease prevention
Drug Resistance, Fungal
Drug Utilization
Drugs
Echinocandins - pharmacology
Echinocandins - therapeutic use
Female
Fungal infections
Genes
Hospitals
Humans
Infectious diseases
Internal Medicine
Life Sciences
Male
Medical Microbiology
Medical sciences
Middle Aged
Mutation
Pharmacology. Drug treatments
Prevalence
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Summary:Since their introduction in the 2000s, echinocandin drugs have become widely used for the treatment and prophylaxis of invasive fungal infections and, notably, invasive candidiasis. Although cases of breakthrough candidiasis in patients receiving echinocandins have been reported, clinical failure during echinocandin treatment due to the acquisition of resistance by a normally susceptible Candida spp. isolate is considered rare. To date, no publications have been published correlating the use of echinocandins and the emergence of echinocandin resistance among Candida species. So, our goal is to report an initial analysis of echinocandin use in relation to the emergence of resistant Candida isolates. We report here a single-centre experience of the emergence of eight resistant isolates belonging to normally susceptible Candida species in six patients receiving echinocandins. We describe the context and analyse the use of echinocandins over the previous decade. For seven of these isolates, we identified FKS gene mutations involved in decreased susceptibility. Seven isolates were obtained in 2011, on the heels of a ten-fold increase in caspofungin use over the preceding decade. In contrast, in 2012, the use of echinocandins decreased in our institution by 19.5 % and, in that year, only one Candida -resistant isolate was detected, despite the stable global epidemiology of invasive candidaemia. This work underlines the necessity of improving the prescription of antifungal drugs. Improvement in the monitoring of strain susceptibility should also be considered in order to better detect the emergence of resistant or non-susceptible yeast strains.
ISSN:0934-9723
1435-4373
DOI:10.1007/s10096-014-2096-9