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Authors Xiao M, Fan X, Hou X, Chen SCA, Wang H, Kong F, Sun ZY, Chu YZ, Xu YC
Received 28 September 2017
Accepted for publication 25 November 2017
Published 23 January 2018 Volume 2018:11 Pages 155—161
DOI https://doi.org/10.2147/IDR.S152785
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Amy Norman
Peer reviewer comments 2
Editor who approved publication: Dr Joachim Wink
Abstract: Echinocandin antifungal agents have become the first-line therapy
for invasive candidiasis (IC) in many countries. Despite their increasing use,
resistance to this class of drug is, overall, still uncommon. Here, we report
two patients from the People’s Republic of China with IC, one with infection
caused by pan-echinocandin-resistant Candida tropicalis and
the other by pan-echinocandin-resistant Candida glabrata .
We also describe the mechanisms of drug resistance of these isolates. The
echinocandin-resistant C. glabrata isolate
was cultured from ascitic fluid of a 46-year-old male patient with
intra-abdominal IC developing after surgery in 2012. This patient had had no
prior antifungal exposure. The echinocandin-resistant C. tropicalis isolate
was cultured from chest drainage fluid of a 60-year-old female patient with
severe coronary disease and lung infection. Prior to culture and identification
of the isolate, the patient had received micafungin treatment for 19 days. Both
isolates were cross-resistant to micafungin, anidulafungin, and caspofungin,
with minimum inhibitory concentration values of ≥2 µg/mL. The amino acid
substitution E655K was found adjacent to the FKS2 HS1
region of the C. glabrata isolate,
while the substitution S80P were found in the FKS1 HS1
region of the C. tropicalis isolate.
This report highlights the emergence of echinocandin resistance in two
important non-albicans Candida species.
Although the overall prevalence of echinocandin resistance is low in the
People’s Republic of China, monitoring of antifungal susceptibility trends in
all Candida species is warranted.
Keywords: Candida tropicalis , Candida glabrata , echinocandins,
antifungal resistance, People’s Republic of China