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Advances in medicine have led to more patients being at risk of fungal infections. Diagnostic tools are limited, but early antifungal treatment is crucial to improve outcome. Hence, not a few patients receive empirical antifungals with the disadvantage of increasing the burden of antifungal drug resistance. From a clinical point of view, it is of interest to understand how commonly resistance occurs, how easy it is induced through therapy, and how often it results in clinical treatment failure. The answer differs and depends on the clinical setting, the type of fungal disease, the class of antifungal agent, and treatment duration. This review provides a comprehensive overview on cross-resistance (CR) and multidrug resistance (MR) occurring in Candida species. Known amino acid substitutions are listed which lead to CR (resistance against ≥two azoles or echinocandins), pan-azole resistance (against all systemically applied azoles), pan-echinocandin resistance (against all echinocandins), or MR (polyene-azole resistance, 5-fluorouracil-azole resistance, and azole-echinocandin resistance). Data are supplemented with treatment results from animal studies and experiences from various case reports. An appraisal will be made based on the current frequency of CR and MR reported in the literature, and subsequently, the impact of CR and MR on patient management will be discussed.
Current Fungal Infection Reports – Springer Journals
Published: Nov 30, 2014
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