FKS1/2-variant independent mechanisms underlying the emergence of resistance in echinocandin-refractory Candida auris infections.

Echinocandin-refractory Candida auris with wild-type FKS1/2 genes shows stepwise resistance linked to genomic instability and cell wall remodeling.

• Why it matters: Understanding resistance mechanisms beyond FKS1/2 mutations is crucial for improving treatment strategies against this global health threat.
• What they did: Sequencing of isolates from two critically ill patients revealed heteroresistance, morphotypic heterogeneity, and increased MICs associated with polyploidy and mutations in stress tolerance pathways.
• The result: Findings suggest that resistance in C. auris can develop through multiple independent mechanisms, including genomic instability and cell wall changes, which may inform future therapeutic approaches.