Candida spp. with Acquired Echinocandin Resistance, France, 2004–20101

Lortholary, and the French Mycoses Study Group 3We report 20 episodes of infection caused by acquired echinocandin-resistant Candida spp.harboring diverse and new Fksp mutations.For 12 patients, initial isolates (low MIC, wild-type Fksp sequence) and subsequent isolates (after caspofungin treatment, high MIC, mutated Fksp) were genetically related.E chinocandins are effective in patients with invasive candidiasis and recommended as fi rst-line therapy, especially for patients with severe sepsis or those previously exposed to azoles or infected with Candida glabrata (1).Fewer than 50 persons infected with echinocandin-resistant species that are usually susceptible, such as C. albicans, C. glabrata, C. tropicalis, and C. krusei, have been described in limited series or case reports (2-4).All species were found in patients preexposed to echinocandins.The major mechanism of resistance is related to mutations in FKS genes coding for β-1,3-glucan-synthase (5), with almost 20 known FKS mutations.We describe the characteristics of infections from caspofungin-resistant Candida spp.isolates belonging to usually susceptible species recorded in France (2004)(2005)(2006)(2007)(2008)(2009)(2010) and analyze their FKS mutations and effect on echinocandin susceptibility.