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Antifungal Resistance: a Concerning Trend for the Present and Future

  • Joshua A. Hendrickson
  • Chenlin Hu
  • Samuel L. Aitken
  • Nicholas BeydaEmail author
Antimicrobial Development and Drug Resistance (K Claeys and A Vega, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Antimicrobial Development and Drug Resistance

Abstract

Purpose of Review

The global emergence of antifungal resistance among Candida spp. and Aspergillus spp. is a growing threat to public health, driven largely by the expanding use of antifungals in both the clinical and agricultural settings. As treatment options remain limited, understanding mechanisms and risk factors for antifungal resistance is essential to retaining their clinical utility.

Recent Findings

Invasive candidiasis is increasingly caused by non-albicans Candida species with reduced susceptibility to first-line antifungals, making empiric treatment decisions difficult. Echinocandin resistance in C. glabrata is increasing at some high-risk centers, and multi-drug-resistant isolates are increasingly encountered. Of large concern is the rapid and global emergence of C. auris, a species associated with a high propensity for developing multi-drug resistance and nosocomial transmission. Azole resistance is now becoming more common in Aspergillus isolates as well, with breakthrough infections occurring in patients previously managed with azoles antifungals. The appearance of azole-resistant Aspergillus isolates in azole-naïve patients is also concerning, given it is now accepted that this may be due to the use of non-human azole compounds in pesticides.

Summary

Due to the climbing use of antifungals in both the clinical and agricultural sectors, the frequency of encounters with antifungal-resistant isolates will undoubtedly rise in parallel. Antifungal stewardship will need to become a new priority for antimicrobial stewardship programs in order to preserve our current selection of antifungal agents. Rapid diagnostics may help stewardship efforts by decreasing the time it takes to determine if an antifungal agent is indicated for a patient.

Keywords

Candida Aspergillus Antifungal resistance Azole Echinocandin Antifungal susceptibility 

Notes

Compliance with Ethical Standards

Conflict of Interest

Dr. Hendrickson, Dr. Hu, and Dr. Aitken have nothing to disclose.

Dr. Beyda has received grant support and is on the advisory board for Astellas Inc.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by either of the authors.

References

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Joshua A. Hendrickson
    • 1
    • 2
  • Chenlin Hu
    • 1
  • Samuel L. Aitken
    • 3
    • 4
  • Nicholas Beyda
    • 1
    • 2
    • 5
    Email author
  1. 1.University of Houston College of PharmacyHoustonUSA
  2. 2.Baylor-St. Luke’s Medical Center HospitalHoustonUSA
  3. 3.The University of Texas MD Anderson Cancer CenterHoustonUSA
  4. 4.Center for Antimicrobial Resistance and Microbial Genomics (CARMiG)UTHealth McGovern Medical SchoolHoustonUSA
  5. 5.Department of Pharmacy Practice and Translational ResearchHealth and Biomedical Sciences Building 2HoustonUSA

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