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Candida glabrata (Nakaseomyces glabratus)

C. glabrata

Morphology: Small yeast, no pseudohyphae. Now classified as Nakaseomyces glabratus.

Yeast

Typical drugs

  1. #1Micafungin— First-line — high intrinsic fluconazole resistance.
  2. #2Caspofungin— Echinocandin alternative.
  3. #3Amphotericin B (liposomal)— If echinocandin resistance or CNS.
  4. #4Fluconazole— ONLY if MIC ≤32 and dose-dependent susceptible (high-dose 800 mg/d).

Empiric therapy when resistant

Start empiric echinocandin for any suspected candidemia in patient with prior azole exposure or unstable host. If echinocandin-resistant: liposomal amphotericin B.

Resistance mechanisms

  • Target alteration

    Reduced azole affinity; FKS1/FKS2 mutations confer echinocandin resistance

    Example: Pan-resistant C. glabrata reported.

Resistance notes

Innately reduced fluconazole susceptibility; echinocandin resistance rising (~5–10%). Pan-resistance documented.

Pearls

2nd most common Candida species in US/Europe. Risk factors: prior fluconazole, advanced age, hematologic malignancy. Don't step down to fluconazole without confirmed susceptibility.

References

  • IDSA Candidiasis Guidelines (2016)