Multidrug-Resistant Candida: Epidemiology, Molecular Mechanisms, and Treatment
Multidrug-Resistant Candida: Epidemiology, Molecular Mechanisms, and Treatment
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DOI：
10.1093/infdis/jix131
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发表时间：
2017-08-15
影响因子：
6.4
通讯作者：
Patterson, Thomas F.
中科院分区：
文献类型：
--
作者：
Arendrup, Maiken Cavling;Patterson, Thomas F.
侵袭性念珠菌感染仍然是发病和死亡的重要原因，特别是在住院和免疫功能低下或危重患者中。只有少数几类药物中的有限数量的抗真菌剂可用于治疗这些严重感染的患者。抵抗可以是内在的，也可以是后天的。耐药机制在念珠菌之间不交换;因此，获得性耐药要么出现在个体患者的抗真菌选择压力下，要么更罕见地由于患者之间耐药菌株的水平传播而发生。虽然多药耐药是罕见的，越来越多的报告，唑类，棘白菌素，多烯发生在几个念珠菌属，最值得注意的是光滑念珠菌和最近的耳念珠菌。驱动因素是整体抗真菌药物的使用，感染/定植部位的亚治疗药物水平，生物膜基质中的药物隔离，以及在爆发的情况下，次优的感染控制。此外，最近的研究表明，DNA错配修复基因突变可能有助于获得耐药突变的C。特别是光滑的抗真菌耐药念珠菌感染的诊断对于成功治疗这些感染的患者至关重要。通过抗真菌药物管理减少不必要的抗真菌药物使用对于限制多药耐药的出现至关重要。
Invasive Candida infections remain an important cause of morbidity and mortality, especially in hospitalized and immunocompromised or critically ill patients. A limited number of antifungal agents from only a few drug classes are available to treat patients with these serious infections. Resistance can be either intrinsic or acquired. Resistance mechanisms are not exchanged between Candida; thus, acquired resistance either emerges in response to an antifungal selection pressure in the individual patient or, more rarely, occur due to horizontal transmission of resistant strains between patients. Although multidrug resistance is uncommon, increasing reports of multidrug resistance to the azoles, echinocandins, and polyenes have occurred in several Candida species, most notably Candida glabrata and more recently Candida auris. Drivers are overall antifungal use, subtherapeutic drug levels at sites of infection/ colonization, drug sequestration in the biofilm matrix, and, in the setting of outbreaks, suboptimal infection control. Moreover, recent research suggests that DNA mismatch repair gene mutations may facilitate acquisition of resistance mutations in C. glabrata specifically. Diagnosis of antifungal-resistant Candida infections is critical to the successful management of patients with these infections. Reduction of unnecessary use of antifungals via antifungal stewardship is critical to limit multidrug resistance emergence.