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Antifungal drug resistance: does it matter?
1Department of Infectious Diseases & Microbiology, Faculty of Medicine, Imperial College, London, UK. t.rogers@ic.ac.uk
Summary
Antifungal drug resistance in invasive fungal infections is rising, particularly with non-albicans Candida species showing reduced susceptibility. Reliable susceptibility testing aids treatment but host and drug factors also impact outcomes.
Area of Science:
- Medical Mycology
- Pharmacology
- Infectious Diseases
Background:
- Antifungal drug resistance is a growing concern in treating invasive fungal infections.
- Increased antifungal use may drive a shift towards more resistant fungal pathogens, like non-albicans Candida species.
Purpose of the Study:
- Review antifungal drug mechanisms of action.
- Define antifungal drug resistance and its mechanisms.
- Evaluate factors influencing antifungal therapy outcomes, including in vitro susceptibility testing and host-related elements.
Main Methods:
- Literature review of antifungal drug action, resistance mechanisms, and clinical outcomes.
- Analysis of epidemiological and host factors impacting treatment success.
- Assessment of in vitro antifungal susceptibility testing methods and their predictive value.
Main Results:
- Antifungal drug resistance in invasive fungal pathogens is increasing.
- Non-albicans Candida species exhibit greater resistance to fluconazole than Candida albicans.
- Established susceptibility breakpoints aid in guiding antifungal therapy.
Conclusions:
- Antifungal drug resistance in yeasts poses a significant clinical challenge.
- In vitro susceptibility testing is increasingly reliable for predicting treatment response.
- Host and drug-specific factors remain crucial determinants of successful antifungal therapy outcomes.