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Will resistance in fungi emerge on a scale similar to that seen in bacteria?

H Hof1

  • 1Institute of Medical Microbiology and Hygiene, University Clinic Mannheim, University of Heidelberg, 68167 Mannheim, Germany. herbert.hof@imh.ma.uni-heidelberg.de

European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology
|January 22, 2008
PubMed

Insights

Fungal resistance to azoles is unlikely to surge despite shared resistance pathways with bacteria. Differences in fungal biology and newer broad-spectrum azoles like posaconazole and voriconazole suggest low resistance emergence risk.

Area of Science:

  • Mycology
  • Antimicrobial Resistance
  • Pharmacology

Background:

  • Increasing use of azole antifungals for invasive fungal infections necessitates evaluating resistance emergence.
  • Bacterial resistance to antibiotics provides a comparative model for potential fungal resistance.

Purpose of the Study:

  • To review shared resistance mechanisms between bacteria and fungi.
  • To assess the likelihood of azole antifungal resistance in fungi.

Main Methods:

  • Comparative analysis of bacterial and fungal resistance pathways.
  • Examination of genetic transfer mechanisms and drug target modifications.
  • Review of azole drug properties and their activity spectrum.

Main Results:

  • Shared resistance pathways include target alteration, overproduction, altered biosynthesis, and efflux pumps.
  • Fungi exhibit limited horizontal gene transfer and longer generation times, slowing resistance spread.
  • No enzymatic inactivation of azoles has been reported in fungi.
  • Broad-spectrum azoles (posaconazole, voriconazole) are effective against most yeasts and molds.

Conclusions:

  • Despite shared mechanisms, significant biological differences between fungi and bacteria suggest a low probability of widespread azole resistance.
  • Newer azoles are likely to prevent the emergence of inherently resistant fungal strains.

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