DeMuri G P, Hostetter M K
Department of Pediatrics, University of Minnesota, Minneapolis, USA.
Pediatr Clin North Am. 1995 Jun;42(3):665-85. doi: 10.1016/s0031-3955(16)38984-2.
The marked increase in the number of patients with AIDS and other forms of immunocompromise has resulted in the emergence of fungi as predominant pathogens in many institutions. Unfortunately, with the widespread use of antifungal agents to combat these infections, reports of resistance to antifungal agents have proliferated. In the present environment, the occurrence of resistance to antifungal agents is neither rare nor of negligible clinical importance. The expanding demand for antifungal agents mandates a new sense of vigilance for resistance. Although newly proposed standards for in vitro susceptibility testing should help to remove the ambiguity surrounding quantitative measurement of fungal resistance, lessons learned in the treatment of bacteria clearly now apply to fungi also: prolonged use of an antimicrobial agent will result in the selection of resistant organisms. The enlarging spectrum of resistance to antifungal agents must prompt aggressive searches for new modes of therapy. Strategies to inhibit fungal colonization, to augment host defenses, or to develop novel antifungal agents from Pseudomonas syringae or from peptide nanotubes are helping to solve this pressing clinical need.
艾滋病患者及其他免疫功能低下形式患者数量的显著增加，导致真菌在许多医疗机构中成为主要病原体。不幸的是，随着抗真菌药物广泛用于对抗这些感染，对抗真菌药物耐药的报告激增。在当前环境下，对抗真菌药物耐药的发生既不罕见，临床重要性也不可忽视。对抗真菌药物不断增长的需求要求对耐药保持新的警惕。尽管新提出的体外药敏试验标准应有助于消除围绕真菌耐药性定量测量的模糊性，但在细菌治疗中学到的经验教训现在显然也适用于真菌：长期使用抗菌药物会导致耐药菌的产生。对抗真菌药物耐药谱的扩大必须促使积极寻找新的治疗模式。抑制真菌定植、增强宿主防御或从丁香假单胞菌或肽纳米管开发新型抗真菌药物的策略，有助于满足这一紧迫的临床需求。
