The emerging of antifungal resistance is a challenge for both microbiologist and physicians. Not only the frequency of infections caused by intrinsically resistant fungal pathogens is increasing, but also the number of infections involving fungi with acquired resistances is on the rise. Fungal pathogens can become resistant against azoles and/or echinocandins during long-term therapy or acquire the resistance in their natural environment. For fungal pathogens that are known to be intrinsically resistant against antifungal compounds, correct species identification is key to target treatment. For fungal species with high rates of acquired antifungal resistances, species identification alone is insufficient to predict treatment outcome. Both antifungal susceptibility testing and molecular diagnostic tools are used to predict treatment outcome. The later are based on mutations in the primary resistance genes of fungal pathogens. For azole, lanosterol 14α-demethylase is the primary target gene, while for echinocandins; resistance is mainly mediated via point mutations in the 1, 3-beta-D-glucan synthase. In this lecture an overview will be provided on these genetic predictors for the major fungal pathogens. Moreover, we will discuss the reliability of these markers for targeting antifungal treatment.
Full conference title:
- ISHAM 20th (2018)