{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T06:14:04Z","timestamp":1788502444829,"version":"build-2803163510"},"reference-count":43,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2023,9,15]],"date-time":"2023-09-15T00:00:00Z","timestamp":1694736000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Mycoses"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p><jats:italic>Candida auris<\/jats:italic> is an emerging, multidrug\u2010resistant yeast, causing outbreaks in healthcare facilities. Echinocandins are the antifungal drugs of choice to treat candidiasis, as they cause few side effects and resistance is rarely found. Previously, immunocompromised patients from Kuwait with <jats:italic>C<\/jats:italic>.\u2009<jats:italic>auris<\/jats:italic> colonisation or infection were treated with echinocandins, and within days to months, resistance was reported in urine isolates. To determine whether the development of echinocandin resistance was due to independent introductions of resistant strains or resulted from intra\u2010patient resistance development, whole genome sequencing (WGS) single\u2010nucleotide polymorphism (SNP) analysis was performed on susceptible (<jats:italic>n<\/jats:italic>\u2009=\u200926) and echinocandin\u2010resistant (<jats:italic>n<\/jats:italic>\u2009=\u20096) isolates from seven patients. WGS SNP analysis identified three distinct clusters differing 17\u2013127 SNPs from two patients, and the remaining isolates from five patients, respectively. Sequential isolates within patients had a maximum of 11 SNP differences over a time period of 1\u201310\u2009months. The majority of isolates with reduced susceptibility displayed unique <jats:italic>FKS1<\/jats:italic> substitutions including a novel <jats:italic>FKS1<\/jats:italic><jats:sup><jats:italic>M690V<\/jats:italic><\/jats:sup> substitution, and nearly all were genetically related, ranging from only three to six SNP differences compared to susceptible isolates from the same patient. Resistant isolates from three patients shared the common <jats:italic>FKS1<\/jats:italic><jats:sup><jats:italic>S639F<\/jats:italic><\/jats:sup> substitution; however, WGS analysis did not suggest a common source. These findings strongly indicate that echinocandin resistance is induced during antifungal treatment. Future studies should determine whether such echinocandin\u2010resistant strains are capable of long\u2010term colonisation, cause subsequent breakthrough candidiasis, have a propensity to cross\u2010infect other patients, or remain viable for longer time periods in the hospital environment.<\/jats:p>","DOI":"10.1111\/myc.13655","type":"journal-article","created":{"date-parts":[[2023,9,15]],"date-time":"2023-09-15T14:19:19Z","timestamp":1694787559000},"page":"1079-1086","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":65,"title":["Whole genome sequencing analysis demonstrates therapy\u2010induced echinocandin resistance in <i>Candida auris<\/i> isolates"],"prefix":"10.1111","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6734-361X","authenticated-orcid":false,"given":"Bram","family":"Spruijtenburg","sequence":"first","affiliation":[{"name":"Department of Medical Microbiology and Infectious Diseases Canisius\u2010Wilhelmina Hospital  Nijmegen The Netherlands"},{"name":"Center of Expertise for Mycology Radboud University Medical Center\/Canisius\u2010Wilhelmina Hospital  Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3492-4781","authenticated-orcid":false,"given":"Suhail","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Medicine Kuwait University  Safat Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3270-055X","authenticated-orcid":false,"given":"Mohammad","family":"Asadzadeh","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Medicine Kuwait University  Safat Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4501-5316","authenticated-orcid":false,"given":"Wadha","family":"Alfouzan","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Medicine Kuwait University  Safat Kuwait"},{"name":"Microbiology Unit, Department of Laboratory Medicine Farwania Hospital  Kuwait City Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inaam","family":"Al\u2010Obaid","sequence":"additional","affiliation":[{"name":"Department of Microbiology Al\u2010Sabah Hospital  Shuwaikh Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5673-1476","authenticated-orcid":false,"given":"Eiman","family":"Mokaddas","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Medicine Kuwait University  Safat Kuwait"},{"name":"Department of Microbiology Ibn\u2010Sina Hospital  Shuwaikh Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0226-024X","authenticated-orcid":false,"given":"Eelco F. 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