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Intensive Care Medicine

, Volume 40, Issue 9, pp 1241–1255 | Cite as

Resistance of Candida spp. to antifungal drugs in the ICU: where are we now?

  • Danièle MaubonEmail author
  • Cécile Garnaud
  • Thierry Calandra
  • Dominique Sanglard
  • Muriel Cornet
Review

Abstract

Current increases in antifungal drug resistance in Candida spp. and clinical treatment failures are of concern, as invasive candidiasis is a significant cause of mortality in intensive care units (ICUs). This trend reflects the large and expanding use of newer broad-spectrum antifungal agents, such as triazoles and echinocandins. In this review, we firstly present an overview of the mechanisms of action of the drugs and of resistance in pathogenic yeasts, subsequently focusing on recent changes in the epidemiology of antifungal resistance in ICU. Then, we emphasize the clinical impacts of these current trends. The emergence of clinical treatment failures due to resistant isolates is described. We also consider the clinical usefulness of recent advances in the interpretation of antifungal susceptibility testing and in molecular detection of the mutations underlying acquired resistance. We pay particular attention to practical issues relating to ICU patient management, taking into account the growing threat of antifungal drug resistance.

Keywords

Antifungal resistance Resistance mechanisms Candida resistance Intensive care unit Clinical resistance Microbial resistance 

Notes

Acknowledgments

We are grateful to Audrey Le Gouëllec for her assistance in preparing the figures.

Conflicts of interest

D. Maubon, C. Garnaud and M. Cornet received a research grant from Pfizer in 2013. T. Calandra: board membership: Pfizer; Consultancy: Pfizer, MSD; Speakers bureaus: BioMérieux, Pfizer; Development & educational presentations: MSD, Gilead Sciences (money to institution); Travel & meeting expenses: Astellas, Pfizer.

Supplementary material

134_2014_3404_MOESM1_ESM.doc (108 kb)
Supplementary material 1 (DOC 108 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2014

Authors and Affiliations

  • Danièle Maubon
    • 1
    • 2
    Email author
  • Cécile Garnaud
    • 1
    • 2
  • Thierry Calandra
    • 3
  • Dominique Sanglard
    • 4
  • Muriel Cornet
    • 1
    • 2
  1. 1.Parasitologie-Mycologie, Institut de Biologie et de PathologieCHU de GrenobleGrenobleFrance
  2. 2.Laboratoire TIMC-TheREx, UMR 5525 CNRS-UJFUniversité Grenoble AlpesGrenobleFrance
  3. 3.Infectious Diseases Service, Department of MedicineCentre Hospitalier Universitaire Vaudois and University of LausanneLausanneSwitzerland
  4. 4.Institute of MicrobiologyCentre Hospitalier Universitaire Vaudois and University of LausanneLausanneSwitzerland

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