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Infections due to non-albicans Candida species are now seen with increasing frequency and in some cases their incidence exceeds that for Candida albicans (Bassetti et al., 2006). Depending on the geographical region, Candida tropicalis ranks from the second to the fourth leading cause of invasive candidiasis (Bassetti et al., 2006; Nucci et al., 2010; Pfaller et al., 2008; Tan et al., 2010). Multiple studies of echinocandins against most C. albicans biofilms have shown them to be effective at concentrations of 2 mg ml or less (Bachmann et al., 2002; Cocuaud et al., 2005; Ferreira et al., 2009; Jacobson et al., 2008, 2009; Kuhn et al., 2002; Miceli et al., 2009a). However, a paradoxical effect (PE) of echinocandins against C. albicans biofilms treated with high concentrations of caspofungin (CFG) has been described (Stevens et al., 2004). This phenomenon has subsequently been described with other echinocandins and other Candida species (Chamilos et al., 2007; Fleischhacker et al., 2008; Melo et al., 2007). This effect appears to be species-, strainand echinocandin-specific (Chamilos et al., 2007; Ferreira et al., 2009; Melo et al., 2007; Miceli et al., 2009a, b) and associated with chitin accumulation and ultrastructural alterations (Bizerra et al., 2011); however, the clinical significance of the PE remains unclear.

In vitro assessment of the antifungal and paradoxical activity of different echinocandins against Candida tropicalis biofilms