Echinocandin Resistance, Susceptibility Testing and Prophylaxis: Implications for Patient Management

摘要: This article addresses the emergence of echinocandin resistance among Candida species, mechanisms resistance, factors that promote and confounding issues surrounding standard susceptibility testing. Fungal infections remain a significant cause global morbidity mortality, especially patients with underlying immunosupression. Antifungal therapy is critical component patient management for acute chronic diseases. Yet, therapeutic choices are limited due to only few drug classes available treat systemic disease. Moreover, problem exacerbated by antifungal which has resulted in difficult manage multidrug resistant strains. Echinocandin drugs now preferred choice range candidiasis. These target inhibit fungal-specific enzyme glucan synthase, responsible biosynthesis key cell wall polymer. Therapeutic failures involving acquisition susceptible organisms like albicans largely rare event. However, recent years, there an alarming trend increased strains glabrata, many cases also azole drugs. always acquired during mechanism well established involve amino acid changes “hot-spot” regions Fks subunits carrying catalytic portion synthase. significantly decrease sensitivity resulting higher MIC values. A responses, from complete partial refractory response, observed depending on nature substitution, clinical responses recapitulated pharmacodynamic models infection. The cellular processes promoting formation complex stress response pathways, yield variety adaptive compensatory genetic responses. Stress-adapted cells become tolerant can form stable FKS mutations continued exposure. major concern detection classical broth microdilution techniques show variability microbiology laboratories certain species. consequence misclassified according breakpoints, this led confusion field. Clinical appear include expanding use agents empiric prophylaxis. Furthermore, host reservoirs such as biofilms gastrointestinal tract or intra-abdominal seed development therapy. fundamental understanding primary molecular mechanism, along emergence, develop better diagnostic tools strategies overcome prevent resistance.