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Echinocandin heteroresistance is a novel concept describing a phenotypically resistant subpopulation that could actively proliferate at a high concentration of a drug and potentially lead to prophylaxis inefficacy. During echinocandin treatment, the susceptible, clonal kins perished, whereas the phenotypically resistant cells survived, replicated, translocated to deeper tissues, and caused systemic infection. The overgrowth of the fungus in the colonisation sites in tandem with virulence and host-related attributes might result in translocation into deeper tissues and result in the failure of antifungal prophylaxis (adapted fromreferences 27 and 38). CFU=colony forming unit.

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