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A pseudo-outbreak of echinocandin-resistant Candida glabrata: The unreliability of caspofungin testing in predicting echinocandin susceptibility.

Results A total of 44 C. glabrata isolates from various body sites were tested (mostly from sterile sites). The baseline echinocandin nonsusceptibility rate prior to the change to caspofungin testing was 5.3% (n 19), which increased to 91.7% (n 12) coinciding with the change to caspofungin testing (p <0.0001). Institution of EUCAST guidelines resulted in a return to baseline echinocandin nonsusceptibility rates of 7.7% (n 13). Retrospective testing of micafungin/anidulafungin-sensitive isolates with caspofungin confirmed erroneous detection of echinocandin resistance based on caspofungin MICs (Figure 2). Objectives Clinical isolates of Candida species typically undergo susceptibility testing (to azoles and echinocandins). Multiple echinocandins are commercially available for in vitro susceptibility testing using an agar gradient diffusion method, including micafungin, caspofungin and anidulafungin. After institutional formulary (and therefore susceptibility testing) was changed from micafungin to caspofungin, we experienced an abrupt increase in echinocandin resistance among clinical isolates of C. glabrata. In this study, we determined and quantified discrepancies in echinocandin testing among three agents and found that caspofungin testing results had overestimated echinocandin resistance.