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Expert Review of Anti-infective Therapy
Article . 2009 . Peer-reviewed
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Antifungal drug resistance mechanisms

Authors: Emilia Cantón; Ana Espinel-Ingroff; Javier Pemán;

Antifungal drug resistance mechanisms

Abstract

Antifungal resistance is a prominent feature in the management of invasive mycoses, with important implications for morbidity and mortality. Microbiological resistance, the most common cause of refractory infection, is associated with a fungal pathogen for which an antifungal MIC is higher than average or within the range designated as the resistant breakpoint. Four major mechanisms of resistance to azoles have been described in Candida spp.: decreased intracellular drug concentration by activation of efflux systems or reduction of drug penetration, modification of the target site, upregulation of the target enzyme and development of bypass pathways. Conversely, echinocandins are a poor substrate for multidrug efflux transporters, and their mechanisms of resistance are associated with point mutations and/or overexpression of FKS1 and FKS2 genes. Acquired resistance to flucytosine results from defects in its metabolism through enzymatic mutations, whereas resistance to amphotericin B may be mediated by increased catalase activity or defects in ergosterol biosynthesis.

Keywords

Azoles, Antifungal Agents, Genes, Fungal, Candidiasis, Flucytosine, Polyenes, Echinocandins, Mycoses, Drug Resistance, Fungal, Mutation, Humans, Candida

  • BIP!
    Impact byBIP!
    citations
    This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
    103
    popularity
    This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
    Top 10%
    influence
    This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
    Top 10%
    impulse
    This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
    Top 10%
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citations
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
103
Top 10%
Top 10%
Top 10%
Green