Tolerance and heteroresistance to echinocandins in Candida auris: conceptual issues, clinical implications, and outstanding questions
ABSTRACT Candida auris is a significant public health threat due to its environmental persistence and multidrug resistance, with echinocandins being the preferred treatment. However, in addition to resistance, echinocandin tolerance and heteroresistance may contribute to treatment challenges. Echino...
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| Format: | Article |
| Language: | English |
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American Society for Microbiology
2025-05-01
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| Series: | mSphere |
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| Online Access: | https://journals.asm.org/doi/10.1128/msphere.00161-25 |
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| author | Erika Shor David S. Perlin Dimitrios P. Kontoyiannis |
| author_facet | Erika Shor David S. Perlin Dimitrios P. Kontoyiannis |
| author_sort | Erika Shor |
| collection | DOAJ |
| description | ABSTRACT Candida auris is a significant public health threat due to its environmental persistence and multidrug resistance, with echinocandins being the preferred treatment. However, in addition to resistance, echinocandin tolerance and heteroresistance may contribute to treatment challenges. Echinocandin tolerance involves reduced drug-mediated killing, while heteroresistance is the ability of a small cell subset to grow at high drug concentrations. These phenomena may facilitate the emergence of full resistance and complicate clinical outcomes. The clinical significance of these mechanisms remains unclear, with limited data correlating them with treatment failures. Research is needed to understand their mechanisms and impact, develop streamlined and robust methods to detect them in clinical settings, and explore mitigation strategies. The pathogen’s range of drug adaptations demands innovative approaches like spatial transcriptomics to dissect these complex responses and improve patient outcomes. |
| format | Article |
| id | doaj-art-b337d8f77bb540f2b918f446ac10aa26 |
| institution | DOAJ |
| issn | 2379-5042 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | American Society for Microbiology |
| record_format | Article |
| series | mSphere |
| spelling | doaj-art-b337d8f77bb540f2b918f446ac10aa262025-08-20T03:14:38ZengAmerican Society for MicrobiologymSphere2379-50422025-05-0110510.1128/msphere.00161-25Tolerance and heteroresistance to echinocandins in Candida auris: conceptual issues, clinical implications, and outstanding questionsErika Shor0David S. Perlin1Dimitrios P. Kontoyiannis2Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey, USACenter for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey, USADepartment of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USAABSTRACT Candida auris is a significant public health threat due to its environmental persistence and multidrug resistance, with echinocandins being the preferred treatment. However, in addition to resistance, echinocandin tolerance and heteroresistance may contribute to treatment challenges. Echinocandin tolerance involves reduced drug-mediated killing, while heteroresistance is the ability of a small cell subset to grow at high drug concentrations. These phenomena may facilitate the emergence of full resistance and complicate clinical outcomes. The clinical significance of these mechanisms remains unclear, with limited data correlating them with treatment failures. Research is needed to understand their mechanisms and impact, develop streamlined and robust methods to detect them in clinical settings, and explore mitigation strategies. The pathogen’s range of drug adaptations demands innovative approaches like spatial transcriptomics to dissect these complex responses and improve patient outcomes.https://journals.asm.org/doi/10.1128/msphere.00161-25Candida aurisechinocandinsheteroresistancetolerance |
| spellingShingle | Erika Shor David S. Perlin Dimitrios P. Kontoyiannis Tolerance and heteroresistance to echinocandins in Candida auris: conceptual issues, clinical implications, and outstanding questions mSphere Candida auris echinocandins heteroresistance tolerance |
| title | Tolerance and heteroresistance to echinocandins in Candida auris: conceptual issues, clinical implications, and outstanding questions |
| title_full | Tolerance and heteroresistance to echinocandins in Candida auris: conceptual issues, clinical implications, and outstanding questions |
| title_fullStr | Tolerance and heteroresistance to echinocandins in Candida auris: conceptual issues, clinical implications, and outstanding questions |
| title_full_unstemmed | Tolerance and heteroresistance to echinocandins in Candida auris: conceptual issues, clinical implications, and outstanding questions |
| title_short | Tolerance and heteroresistance to echinocandins in Candida auris: conceptual issues, clinical implications, and outstanding questions |
| title_sort | tolerance and heteroresistance to echinocandins in candida auris conceptual issues clinical implications and outstanding questions |
| topic | Candida auris echinocandins heteroresistance tolerance |
| url | https://journals.asm.org/doi/10.1128/msphere.00161-25 |
| work_keys_str_mv | AT erikashor toleranceandheteroresistancetoechinocandinsincandidaaurisconceptualissuesclinicalimplicationsandoutstandingquestions AT davidsperlin toleranceandheteroresistancetoechinocandinsincandidaaurisconceptualissuesclinicalimplicationsandoutstandingquestions AT dimitriospkontoyiannis toleranceandheteroresistancetoechinocandinsincandidaaurisconceptualissuesclinicalimplicationsandoutstandingquestions |