Antifungal Resistance in Cryptococcal Infections.
Marcia de Souza Carvalho MelhemDiniz Pereira Leite JúniorJuliana P F TakahashiMilena Bronze MacioniLidiane de OliveiraLisandra Siufi de AraújoWellington Santos FavaLucas X BonfiettiAnamaria Mello Miranda PaniagoJames VenturiniAna Espinel-IngroffPublished in: Pathogens (Basel, Switzerland) (2024)
Antifungal therapy, especially with the azoles, could promote the incidence of less susceptible isolates of Cryptococcus neoformans and C. gattii species complexes (SC), mostly in developing countries. Given that these species affect mostly the immunocompromised host, the infections are severe and difficult to treat. This review encompasses the following topics: 1. infecting species and their virulence, 2. treatment, 3. antifungal susceptibility methods and available categorical endpoints, 4. genetic mechanisms of resistance, 5. clinical resistance, 6. fluconazole minimal inhibitory concentrations (MICs), clinical outcome, 7. environmental influences, and 8. the relevance of host factors, including pharmacokinetic/pharmacodynamic (PK/PD) parameters, in predicting the clinical outcome to therapy. As of now, epidemiologic cutoff endpoints (ECVs/ECOFFs) are the most reliable antifungal resistance detectors for these species, as only one clinical breakpoint (amphotericin B and C. neoformans VNI) is available.
Keyphrases
- candida albicans
- genetic diversity
- biofilm formation
- escherichia coli
- pseudomonas aeruginosa
- staphylococcus aureus
- stem cells
- risk assessment
- early onset
- intensive care unit
- genome wide
- dna methylation
- cystic fibrosis
- bone marrow
- mesenchymal stem cells
- extracorporeal membrane oxygenation
- mechanical ventilation
- smoking cessation