Mycology Reference Laboratory, Centro Nacional de Microbiologia, Instituto de Salud Carlos III, Madrid, Spain.
Br J Haematol. 2014 Aug;166(4):471-84. doi: 10.1111/bjh.12896. Epub 2014 Apr 18.
Mortality linked to invasive fungal diseases remains very high despite the availability of novel antifungals and new therapeutic strategies. Candida albicans and Aspergillus fumigatus account for most invasive mycosis produced by yeast or moulds, respectively. Other Candida non-albicans are increasingly being reported and newly emerging, as well as cryptic, filamentous fungi often cause disseminated infections in immunocompromised hosts. Management of invasive fungal infections is becoming a challenge as emerging fungal pathogens generally show poor response to many antifungals. The ability of reference antifungal susceptibility testing methods to detect emerging resistance patterns, together with the molecular characterization of antifungal resistance mechanisms, are providing useful information to optimize the effectiveness of antifungal therapy. The current status of antifungal resistance epidemiology with special emphasis on the molecular resistant mechanisms that have been described in the main pathogenic fungal species are reviewed.
尽管有新型抗真菌药物和新的治疗策略，侵袭性真菌病相关死亡率仍然很高。白色念珠菌和烟曲霉分别是由酵母或霉菌引起的侵袭性真菌感染的主要病原体。其他非白念珠菌越来越多地被报道，新出现的以及隐匿性丝状真菌常常在免疫功能低下的宿主中引起播散性感染。由于新兴的真菌病原体通常对抗真菌药物反应不佳，侵袭性真菌感染的治疗管理正变得越来越具有挑战性。参考抗真菌药敏试验方法检测新兴耐药模式的能力，以及对抗真菌耐药机制的分子特征分析，为优化抗真菌治疗的效果提供了有用的信息。本文综述了抗真菌耐药流行病学的现状，特别强调了主要致病性真菌种中已描述的分子耐药机制。
