Abdominal candidiasis is a hidden reservoir of echinocandin resistance

Area of Science:

• Medical Mycology
• Infectious Diseases
• Antimicrobial Resistance

Background:

• Echinocandins are crucial antifungal agents for treating invasive Candida infections.
• The emergence of antifungal resistance, particularly to echinocandins, poses a significant clinical challenge.
• Abdominal candidiasis represents a complex and often severe form of invasive fungal infection.

Purpose of the Study:

• To investigate the prevalence and characteristics of echinocandin-resistant Candida isolates in patients with abdominal candidiasis.
• To identify risk factors associated with the emergence of FKS mutant Candida strains.
• To assess the clinical implications of echinocandin resistance in abdominal candidiasis.

Main Methods:

• Retrospective analysis of Candida isolates from patients with abdominal candidiasis.
• Genotypic identification of FKS mutations conferring echincoandin resistance.
• Antimicrobial susceptibility testing and detection of co-infections with multidrug-resistant bacteria.

Main Results:

• FKS mutant Candida strains were recovered from 24% of patients exposed to echinocandins.
• Candida glabrata and Candida albicans were the most common species identified with FKS mutations.
• Multidrug-resistant bacteria were prevalent in FKS mutant infections (83%).
• FKS mutations were significantly associated with prolonged echinocandin exposure, breakthrough infections, and therapeutic failures.

Conclusions:

• Abdominal candidiasis serves as a reservoir for the development of echinocandin-resistant Candida.
• The presence of FKS mutations in Candida isolates from abdominal candidiasis is associated with poor treatment outcomes.
• Early detection and management strategies are crucial to combat the spread of antifungal resistance in these challenging infections.