Arastehfar Amir, Gabaldón Toni, Garcia-Rubio Rocio, Jenks Jeffrey D, Hoenigl Martin, Salzer Helmut J F, Ilkit Macit, Lass-Flörl Cornelia, Perlin David S
Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA.
Life Sciences Programme, Supercomputing Center (BSC-CNS), Jordi Girona, 08034 Barcelona, Spain.
Antibiotics (Basel). 2020 Dec 8;9(12):877. doi: 10.3390/antibiotics9120877.
The high clinical mortality and economic burden posed by invasive fungal infections (IFIs), along with significant agricultural crop loss caused by various fungal species, has resulted in the widespread use of antifungal agents. Selective drug pressure, fungal attributes, and host- and drug-related factors have counteracted the efficacy of the limited systemic antifungal drugs and changed the epidemiological landscape of IFIs. Species belonging to , , , and are among the fungal pathogens showing notable rates of antifungal resistance. Drug-resistant fungi from the environment are increasingly identified in clinical settings. Furthermore, we have a limited understanding of drug class-specific resistance mechanisms in emerging species. The establishment of antifungal stewardship programs in both clinical and agricultural fields and the inclusion of species identification, antifungal susceptibility testing, and therapeutic drug monitoring practices in the clinic can minimize the emergence of drug-resistant fungi. New antifungal drugs featuring promising therapeutic profiles have great promise to treat drug-resistant fungi in the clinical setting. Mitigating antifungal tolerance, a prelude to the emergence of resistance, also requires the development of effective and fungal-specific adjuvants to be used in combination with systemic antifungals.
侵袭性真菌感染（IFI）带来的高临床死亡率和经济负担，以及各种真菌物种导致的大量农作物损失，使得抗真菌药物被广泛使用。选择性药物压力、真菌特性以及宿主和药物相关因素削弱了有限的全身性抗真菌药物的疗效，并改变了IFI的流行病学格局。属于、、和的物种是显示出显著抗真菌耐药率的真菌病原体之一。临床环境中越来越多地发现来自环境的耐药真菌。此外，我们对新兴物种中特定药物类别的耐药机制了解有限。在临床和农业领域建立抗真菌管理计划，并在临床中纳入物种鉴定、抗真菌药敏试验和治疗药物监测实践，可以最大限度地减少耐药真菌的出现。具有有前景治疗特性的新型抗真菌药物在临床环境中治疗耐药真菌有很大前景。减轻抗真菌耐受性（耐药出现的前奏）还需要开发有效的真菌特异性佐剂与全身性抗真菌药物联合使用。
