Costa-de-Oliveira Sofia, Rodrigues Acácio G
Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto, Al. Hernâni Monteiro, 4200-319 Porto, Portugal.
Center for Research in Health Technologies and Information Systems (CINTESIS), R. Dr. Plácido da Costa, 4200-450 Porto, Portugal.
Microorganisms. 2020 Jan 22;8(2):154. doi: 10.3390/microorganisms8020154.
represents the most frequent isolated yeast from bloodstream infections. Despite the remarkable progress in diagnostic and therapeutic approaches, these infections continue to be a critical challenge in intensive care units worldwide. The economic cost of bloodstream fungal infections and its associated mortality, especially in debilitated patients, remains unacceptably high. is a highly adaptable microorganism, being able to develop resistance following prolonged exposure to antifungals. Formation of biofilms, which diminish the accessibility of the antifungal, selection of spontaneous mutations that increase expression or decreased susceptibility of the target, altered chromosome abnormalities, overexpression of multidrug efflux pumps and the ability to escape host immune defenses are some of the factors that can contribute to antifungal tolerance and resistance. The knowledge of the antifungal resistance mechanisms can allow the design of alternative therapeutically options in order to modulate or revert the resistance. We have focused this review on the main factors that are involved in antifungal resistance and tolerance in patients with C. albicans bloodstream infections.
是血流感染中最常分离出的酵母菌。尽管在诊断和治疗方法上取得了显著进展，但这些感染仍是全球重症监护病房面临的严峻挑战。血流真菌感染的经济成本及其相关死亡率，尤其是在体弱患者中，仍然高得令人无法接受。是一种高度适应性强的微生物，长时间接触抗真菌药物后能够产生耐药性。生物膜的形成会降低抗真菌药物的可及性，选择增加靶标表达或降低其敏感性的自发突变、染色体异常改变、多药外排泵的过度表达以及逃避宿主免疫防御的能力等，都是导致抗真菌耐受性和耐药性的一些因素。对抗真菌耐药机制的了解有助于设计替代治疗方案，以调节或逆转耐药性。我们将本综述聚焦于白色念珠菌血流感染患者中抗真菌耐药性和耐受性的主要相关因素。
