Candidemia surveillance in Iowa: emergence of echinocandin resistance

We performed prospective surveillance for candidemia at 14 Iowa hospitals in 2011-2012. A total of 163 episodes were analyzed. Candida albicans (n = 69 [42%]) and Candida glabrata (n = 58 [36%]) were the most common species. Antifungal resistance was uncommon; 9% of C. glabrata were fluconazole resistant, and 5% (3 isolates) were intermediate or resistant to 1 or more of the echinocandins. Molecular analyses of the fks1 and fks2 hotspots of the C. glabrata revealed no mutations except in 2 of these 3 isolates (L628R and S629P in fks1). Compared with previous surveillance performed in 1998-2001, there was a decrease in proportion of candidemia due to C. albicans (58 to 42%) and an increased proportion due to C. glabrata (20 to 36%). Further emergence of echinocandin resistance among the increasingly common species C. glabrata would complicate the management of this life-threatening infection.