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Multidrug- and Cross-Resistant Candida: the Looming Threat

  • Current Management of Fungal Infections (L Ostrosky-Zeichner, Section Editor)
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Abstract

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.

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Acknowledgement

This work was supported by EraNet funding (Austrian Science Fund, Project ZFI006560/AspBIOmics).

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Conflict of Interest

M. Lackner has received honoraria for invited talks by the pharmaceutical company Forest Pharmaceuticals. In the past 5 years, C. Lass-Flörl has received grant support from the Austrian Science Fund (FWF), MFF Tirol, Astellas Pharma, Gilead Sciences, Pfizer, Schering Plough, and Merck Sharp & Dohme. She has been an advisor/consultant to Gilead Sciences, Merck Sharp & Dohme, Pfizer, and Schering Plough. She has received travel/accommodation expenses from Gilead Sciences, Merck Sharp & Dohme, Pfizer, Astellas, and Schering Plough and has been paid for talks on behalf of Gilead Sciences, Merck Sharp & Dohme, Pfizer, Astellas, and Schering Plough. A. Martin-Vicente has no potential conflict of interest to state.

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

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Authors and Affiliations

  1. Division of Hygiene and Medical Microbiology, Innsbruck Medical University, Schöpfstrasse 41, 6020, Innsbruck, Austria

    Michaela Lackner

  2. Unitat de Microbiologia, Facultat de Medicina i Ciències de la Salut, IISPV, Universitat Rovira i Virgili, Carrer Sant Llorenç, 21, 43201, Reus, Spain

    Adela Martin-Vicente

  3. Division of Hygiene and Medical Microbiology, Innsbruck Medical University, Schöpfstrasse 41, 6020, Innsbruck, Austria

    Cornelia Lass-Flörl

Authors
  1. Michaela Lackner
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  2. Adela Martin-Vicente
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  3. Cornelia Lass-Flörl
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Correspondence to Cornelia Lass-Flörl.

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This article is part of the Topical Collection on Current Management of Fungal Infections

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Lackner, M., Martin-Vicente, A. & Lass-Flörl, C. Multidrug- and Cross-Resistant Candida: the Looming Threat. Curr Fungal Infect Rep 9, 23–36 (2015). https://doi.org/10.1007/s12281-014-0210-1

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