Reports of echinocandin breakthrough or echinocandin-resistant invasive candidiasisa

Case reportReference(s)Host underlying disease/indicationbSite of cultureDrug usedDrug exposure (days)Candida speciesMIC (μg/ml)cFksp amino acid substitutiond
Breakthrough onWagner et al., 2005 (49)HSCT/prophylaxisBloodCAS11 C. famata NR
    echinocandinPark et al., 2005 (39)FNBloodCAS14 C. albicans >81: S645F
    therapyFNMouth28 C. albicans 41: S645F
FNStool17 C. krusei 321: R1361G
Cheung et al., 2006 (6)Abdominal abscess/treatmentBloodCAS12 C. parapsilosis 0.25NR
Krogh-Madsen et al., 2006 (24)OLT/treatmentBiliaryCAS135 C. glabrata >8NR
Kabbara et al., 2008 (21)HSCT/prophylaxisBloodCAS41 C. parapsilosis 218NR
HSCT/prophylaxisBloodCAS50 C. parapsilosis 218NR
HSCT/prophylaxisBloodCAS26 C. guilliermondii 10.52NR
Garcia-Effron et al., 2008 (13)FNBloodCAS15 C. tropicalis 1421: S80S/Pe
HSCT/prophylaxisBloodCAS44 C. tropicalis 2421: S80S/Pe
Malignancy/treatmentCVCCAS21 C. tropicalis 0.510.51: F76Le
EchinocandinHernandez et al., 2004 (17)HIVThroatCAS90 C. albicans >64NR
    failure with in Moudgal et al., 2005 (33)IEBloodCAS42 C. parapsilosis 2>16>16NR
    vitro resistancePelletier et al., 2005 (40)Abdominal abscessBloodCAS13 C. krusei 2NR
Laverdiere et al., 2006 (27)HIVThroatCAS → MCF∼250 C. albicans 1221: S645P; 1: R1361H
Miller et al., 2006 (31)HIVThroatCAS∼450 C. albicans 81: S645P
Hakki et al., 2006 (15), and Kahn et al., 2007 (22)AMLThroatCAS17 C. krusei 4841: P655C/P
Baixench et al., 2007 (3)HIVThroatCAS21 C. albicans 211: F641S
Thompson et al., 2008 (47)OLTPeritonealCAS40 C. glabrata 0.520.252: F659V
Cleary et al., 2008 (8)MOFBloodCAS∼28 C. glabrata >2>2>21: D632E
  • a ANF, anidulafungin; AML, acute myelogenous leukemia; BOLT, bilateral orthotopic lung transplant; CAS, caspofungin; FN, febrile neutropenia; HD, hemodialysis; HIV, human immunodeficiency virus; HSCT, hematopoietic stem cell transplant; MCF, micafungin; MOF, multiorgan failure; NR, not reported; OLT, orthotopic liver transplant.

  • b Treatment is defined as therapy of prior documented invasive candidiasis.

  • c MIC determination was done by the M27-A3 method except for that of Baixench et al. (2007) (EUCAST); MICs not reported are left blank.

  • d The number preceding the colon denotes either 1 for Fks1p or 2 for Fks2p. After the colon, the first letter and following 3-digit number represent the wild-type amino acid for that position in the protein; the last letter denotes the resultant amino acid change from the gene mutation. In cases of diploid organisms, heterozygous mutations are annotated by 2 letters (example, S/P).

  • e For Fks1p, the C. tropicalis amino acid position numbers 76 and 80 are the equivalents of C. albicans amino acid numbers 641 and 645, respectively.