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Refractory fungal infection: Three case reports highlighting good practice
Rosemary Barnes1, David A Enoch2, Wendy Ingram3
1Cardiff University School of Medicine, Heath Park Way, CF14 4YS, Cardiff, United Kingdom.
Abstract:
Refractory invasive fungal disease is a significant clinical problem, with high morbidity, mortality and costs. The complex causes of refractory infection include breakthrough infection due to antifungal resistance (both innate and acquired), suboptimal therapy and impaired immune responses in critically ill or immunocompromised patients. This case series details three reports on the identification and management of refractory fungal infections, two cases of azole resistance and one case of resistant candidiasis, highlighting the importance of accurate diagnosis, monitoring, implementation of biomarkers (serological markers, PCR), antifungal susceptibility testing and antifungal stewardship to optimise management and minimise risks of emergence of drug resistance.
Insights
Refractory invasive fungal infections pose a significant clinical challenge. This case series emphasizes accurate diagnosis, biomarker use, and antifungal stewardship to combat antifungal resistance and improve patient outcomes.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Clinical Microbiology
Background:
- Refractory invasive fungal disease presents a major clinical challenge with substantial morbidity, mortality, and healthcare costs.
- Complex etiologies include antifungal resistance (innate and acquired), inadequate treatment, and compromised immune responses in vulnerable patients.
- Antifungal resistance is a growing concern, necessitating improved diagnostic and therapeutic strategies.
Purpose of the Study:
- To present a case series detailing the identification and management of refractory fungal infections.
- To highlight challenges posed by azole resistance and resistant candidiasis.
- To underscore the importance of integrated approaches in managing difficult-to-treat fungal infections.
Main Methods:
- Case series reporting on three patients with refractory fungal infections.
- Inclusion of diagnostic methods such as serological markers and polymerase chain reaction (PCR).
- Emphasis on antifungal susceptibility testing and antifungal stewardship protocols.
Main Results:
- Two cases demonstrated azole resistance, while one case involved resistant candidiasis.
- Successful management strategies were implemented based on accurate diagnosis and tailored therapy.
- The series illustrates the clinical impact of emerging drug resistance in fungal pathogens.
Conclusions:
- Accurate diagnosis, including the use of biomarkers and susceptibility testing, is crucial for refractory fungal infections.
- Antifungal stewardship is essential to optimize treatment and mitigate the emergence of drug resistance.
- Integrated management strategies are vital for improving outcomes in patients with complex fungal diseases.
