مقالات پذیرفته شده در هشتمین کنگره بین المللی زیست پزشکی
The Rise of Antifungal Resistance in Clinical Mycology: Mechanisms, Clinical Impact, and Emerging Therapeutic Strategies
The Rise of Antifungal Resistance in Clinical Mycology: Mechanisms, Clinical Impact, and Emerging Therapeutic Strategies
Samaneh Safaei,1,*
1. Bachelor student of Midwifery, Azad University of Tonekabon
Introduction: Antifungal resistance has become a significant challenge in clinical mycology, particularly for immunocompromised patients. Fungi such as Candida auris, Aspergillus fumigatus, and Cryptococcus neoformans are increasingly resistant to major antifungal drug classes, including Azoles, Echinocandins, and Polyenes. This resistance is driven by the overuse of antifungals in healthcare and agriculture, making these infections difficult to treat. With limited antifungal agents available, the rise of multidrug-resistant fungi poses an exacerbating global health crisis. This review accumulates current research on resistance mechanisms, clinical implications, and novel therapeutic approaches.
Methods: A systematic review from 2013 to 2023 was administered using databases like PubMed, Scopus, and Web of Science. Search terms included "antifungal resistance," "clinical mycology," "Candida auris," "Aspergillus fumigatus," and "emerging antifungal treatments." Articles were selected based on their relevance to resistance mechanisms, epidemiological trends, and therapeutic strategies. Molecular mechanisms of resistance and clinical outcomes were key focus areas, along with advancements in antifungal drug development and diagnostic tools.
Results: The review highlights a significant rise in antifungal-resistant fungal pathogens, notably Candida auris, that is resistant to multiple antifungal classes. Candida auris has caused outbreaks in healthcare settings, spreading rapidly in hospitals due to its persistence on surfaces and resistance to disinfectants. Mechanisms of resistance include mutations in drug target sites, increased efflux pump activity, and biofilm formation. Aspergillus fumigatus resistance, particularly to Azoles, is linked to mutations in the CYP51A enzyme and environmental exposure to agricultural Azoles. Similarly, Cryptococcus neoformans demonstrates resistance to Azoles and Polyenes, posing treatment challenges in immunocompromised patients.
The clinical impact of antifungal resistance is profound. Patients infected with resistant fungi experience higher mortality rates, extended hospital stays, and increased healthcare costs. Resistant infections require more aggressive treatment approaches, which may involve higher doses of toxic antifungal drugs or a lack of effective treatments altogether. Delayed diagnosis due to traditional diagnostic limitations further escalates patient outcomes, as resistant strains often go undetected until treatment failure.
Emerging therapeutic strategies provide hope in addressing resistance. Novel antifungal agents, including next-generation Azoles and Echinocandins, are under development, showing improved efficacy against resistant strains. Combination therapies using multiple antifungal drugs are being explored to enhance treatment outcomes and reduce the development of resistance. Additionally, immunotherapies and host-directed therapies aim to strengthen the immune response to fungal infections. New diagnostic technologies, such as next-generation sequencing and rapid susceptibility testing, are improving the timely detection of resistant strains, leading to earlier intervention.
Conclusion: Antifungal resistance poses a growing global health threat, complicating the management of fungal infections in clinical settings. The increasing prevalence of resistant pathogens such as Candida auris and Aspergillus fumigatus highlights the urgent need for novel antifungal agents and improved diagnostic capabilities. Addressing this issue requires coordinated global efforts, including better infection control, enhanced surveillance, and investment in antifungal research. As resistance continues to rise, there is an immediate need for innovative therapeutic strategies to confirm effective management of fungal infections in the future.