{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T04:56:09Z","timestamp":1790571369865,"version":"4.1.0"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>This pharmacovigilance study analyzed echinocandin-related adverse events (AEs) using the FDA Adverse Event Reporting System (FAERS) database to identify agent-specific safety signals and inform clinical decision-making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>AE reports were extracted from FAERS covering Q1 2004 to Q4 2025. Four disproportionality algorithms\u2014reporting odds ratio (ROR), proportional reporting ratio (PRR), information component (IC025), and empirical Bayesian geometric mean (EBGM05)\u2014were applied. Positive signals were defined when all four methods yielded positive results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 5,298 cases with echinocandins as the primary suspect drug were included. Caspofungin showed unique association with DRESS syndrome (ROR\u2009=\u200916.62, IC025\u2009=\u20093.21). Exceptionally strong resistance signals were detected for caspofungin (\u201cpathogen resistance\u201d: ROR\u2009=\u200968.83; \u201cdrug resistance\u201d: ROR\u2009=\u200922.32) and micafungin (\u201cbronchopulmonary aspergillosis\u201d: ROR\u2009=\u200971.99; \u201cCandida infection\u201d: ROR\u2009=\u200923.93). Hepatobiliary signals included cholestasis (ROR\u2009=\u200924.97) and alkaline phosphatase increase (ROR\u2009=\u200919.10) for caspofungin, with similar signals observed for micafungin and anidulafungin.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This pharmacovigilance study identified two clinically significant signals: DRESS as a unique safety concern for caspofungin, and striking resistance signals for caspofungin and micafungin. These findings emphasize the need for vigilant monitoring during echinocandin therapy and reinforce antifungal stewardship.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1957674","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T04:28:38Z","timestamp":1790569718000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Systematic analysis of echinocandin-associated adverse reactions using the FAERS database: identification of unique DRESS and resistance signals"],"prefix":"10.3389","volume":"13","author":[{"given":"Xue","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Pharmacy, The People's Hospital of Yubei District of Chongqing City","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji","family":"Nie","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The People's Hospital of Yubei District of Chongqing City","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanchun","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The People's Hospital of Yubei District of Chongqing City","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ya","family":"Ran","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The People's Hospital of Yubei District of Chongqing City","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanhan","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The People's Hospital of Yubei District of Chongqing City","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The People's Hospital of Yubei District of Chongqing City","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e428","DOI":"10.1016\/s1473-3099(23)00692-8","article-title":"Global incidence and mortality of severe fungal disease","volume":"24","author":"Denning","year":"2024","journal-title":"Lancet Infect Dis"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e0167025","DOI":"10.1128\/aac.01670-25","article-title":"Safety and efficacy of echinocandin antifungal agents in Candida albicans endophthalmitis","volume":"70","author":"Zhang","year":"2026","journal-title":"Antimicrob Agents Chemother"},{"key":"B3","doi-asserted-by":"publisher","first-page":"S612","DOI":"10.1093\/cid\/civ791","article-title":"Echinocandin resistance in candida","volume":"61","author":"Perlin","year":"2015","journal-title":"Clin Infect Dis"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1093\/cid\/civ933","article-title":"Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America","volume":"62","author":"Pappas","year":"2016","journal-title":"Clin Infect Dis"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1016\/j.cmi.2018.01.002","article-title":"Diagnosis and management of aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline, clinical microbiology and infection: the official publication of the","volume":"24","author":"Ullmann","year":"2018","journal-title":"Clin Microbiol Infect"},{"key":"B6","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1111\/1469-0691.12038","article-title":"ESCMID* guideline for the diagnosis and management of candida diseases 2012: diagnostic procedures","volume":"18","author":"Cuenca-Estrella","year":"2012","journal-title":"Clin Microbiol Infect"},{"key":"B7","doi-asserted-by":"publisher","first-page":"i14","DOI":"10.1093\/jac\/dkx445","article-title":"What has changed in the treatment of invasive candidiasis? 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