Characterisation of breakthrough invasive mycoses in echinocandin recipients: an evidence-based review

The echinocandins have emerged as important antifungal agents in the current era. Despite their potent antifungal activity, breakthrough invasive mycoses occur in echinocandin recipients, however their precise incidence and causative pathogens are not well delineated. This review shows that breakthrough mycoses occur in 2.4% of patients receiving echinocandins as prophylaxis and are predominantly due to non-albicans Candida spp. and less frequently to invasive aspergillosis. Candida isolates demonstrating reduced susceptibility occurred following prolonged exposure to the echinocandins, primarily in severely immunocompromised patients, and manifested as recurrent episodes of candidaemia or invasive candidiasis.