Candida albicans (C. albicans) is the most common organism responsible for candidiasis in Japan [1], which is often susceptible to Fluconazole (FLCZ) but may be resistant at a rate of 0.6–1.7 % [2]. The IDSA guidelines recommend the use of echinocandins as the initial treatment for candidemia with or without neutropenia, with few side effects, requiring no dose adjustment for renal function or dialysis, and providing effective blood levels at sites of infection other than the eye, central nervous system, and urine. Additionally, they exhibit significant fungicidal activity against most Candida species, making Echinocandin the recommended initial treatment for adult candidiasis [3]. Echinocandin-resistant C. albicans is still rare but is being increasingly reported worldwide, which raises our concern. The SENTRY Antifungal Surveillance Program, conducted in 135 medical centers located in 39 countries in North America (NA), Europe (EUR), Latin America (LATAM), and the Asia-Pacific (APAC) region, showed that the micafungin resistance rates for C. albicans isolates were 0.1 % in NA and EUR, but not in LATAM and APAC, from to 1997–2016 [4].

In Japan, at least three echinocandin-resistant C. albicans strains were confirmed through nosocomial surveillance by the end of 2015 [5,6]. Herein, we report a case of echinocandin-resistant C. albicans at our hospital. Mutations in the FKS gene that cause echinocandin resistance in Candida species have been detected [7,8].