Journal Article

Resistance to Antifungal Agents: Mechanisms and Clinical Impact

Zeina A. Kanafani and John R. Perfect

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 46, issue 1, pages 120-128
Published in print January 2008 | ISSN: 1058-4838
Published online January 2008 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/524071
Resistance to Antifungal Agents: Mechanisms and Clinical Impact

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Despite advances in preventive, diagnostic, and therapeutic interventions, invasive fungal infections cause significant morbidity and mortality in immunocompromised patients. The burden of antifungal resistance in such high-risk patients is becoming a major concern. A better understanding of the mechanisms and clinical impact of antifungal resistance is essential to the prompt and efficient treatment of patients with invasive mycoses and to improving the outcome of such infections. Although recent guidelines have attempted to standardize antifungal susceptibility testing, limitations still exist as a result of the incomplete correlation between in vitro susceptibility and clinical response to treatment. Four major mechanisms of resistance to azoles have been identified, all of which rely on altered gene expression. Mechanisms responsible for polyene and echinocandin resistance are less well understood. In addition to discussing the molecular mechanisms of antifungal resistance, this article elaborates on the concept of clinical resistance, which is critical to the understanding of treatment failure in patients with invasive fungal infections.

Journal Article.  6912 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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