Update on antifungal resistance in Aspergillus and Candida

Arendrup, M.C.

doi:10.1111/1469-0691.12513

Cited by 240Antifungal resistance and susceptibilityAntibiotic Resistance in BacteriaFungal Plant Pathogen Control

Update on antifungal resistance in Aspergillus and Candida

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Arendrup, M.C.·2014·Clinical Microbiology and Infection

DOI 10.1111/1469-0691.12513

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Abstract

Antifungal resistance in Candida and Aspergillus may be either intrinsic or acquired and may be encountered in the antifungal drug exposed but also the antifungal drug-naïve patient. Prior antifungal treatment confers a selection pressure and notoriously raises the awareness of possible resistance in patients failing therapy, thus calling for susceptibility testing. On the contrary, antifungal resistance in the drug-naïve patient is less expected and therefore more challenging. This is particularly true when it concerns pathogens with acquired resistance which cannot be predicted from the species identification itself. This scenario is particularly relevant for A. fumigatus infections due to the increasing prevalence of azole-resistant isolates in the environment. For Candida, infections resistance is most common in the context of increasing prevalence of species with intrinsic resistance. Candida glabrata which has intrinsically reduced susceptibility to fluconazole is increasingly common particularly among the adult and elderly population on the Northern Hemisphere where it may be responsible for as many as 30% of the blood stream infections in population-based surveillance programmes. Candida parapsilosis is prevalent in the paediatric setting, at centres with increasing echinocandin use and at the southern or pacific parts of the world. In the following, the prevalence and drivers of intrinsic and acquired resistance in Aspergillus and Candida will be reviewed.

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C. albicans, naturally susceptible to all drugs, used to account for 85% of the cases before the advent of antimycotics.
“This is a significant change as C. albicans, naturally susceptible to all drugs, used to account for 85% of the cases before the advent of antimycotics [42].”
From Evolutionary Emergence of Drug Resistance in Candida Opportunistic Pathogens (2018) · cites this paper as [42]
Currently, 20-30% of candidemia cases involve species with intrinsic resistance to either fluconazole or echinocandins.
“Currently, 20–30% of candidemia cases involve species with intrinsic resistance to either fluconazole or echinocandins [42].”
From Evolutionary Emergence of Drug Resistance in Candida Opportunistic Pathogens (2018) · cites this paper as [42]

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Authors: Arendrup, M. C.
Affiliations: Statens Serum Institut (DK)
Corresponding author: Arendrup, M.C.
ORCID: Arendrup, M.C.
Venue: Clinical Microbiology and Infection
Publisher: Elsevier BV
Published: 2014-06
Volume: 20
Pages: 42-48
ISSN: 1198-743X (ISSN-L)
DOI: 10.1111/1469-0691.12513
OpenAlex: W1800819261
Cited by: 240
References: 69
Citations by year: 2026: 13 · 2025: 13 · 2024: 11 · 2023: 17 · 2022: 12 · 2021: 11 · 2020: 21 · 2019: 23 · 2018: 31 · 2017: 38 · 2016: 24 · 2015: 15 · 2014: 11
FWCI: 2.15
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 365 d)
Locations: Clinical Microbiology and Infection (publishedVersion)
PubMed (publishedVersion)
Funders: European Society of Clinical Microbiology and Infectious Diseases
Topics: Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Medicine › Antibiotic Resistance in Bacteria
Life Sciences › Agricultural and Biological Sciences › Ecology, Evolution, Behavior and Systematics › Fungal Plant Pathogen Control
Keywords: antifungal resistance, Aspergillus, Candida, intrinsic resistance, acquired resistance, Candida glabrata, Candida parapsilosis, Aspergillus fumigatus, azole resistance, fluconazole resistance, echinocandin resistance, susceptibility testing, bloodstream infection, environmental resistance
MeSH terms: Antifungal Agents, Aspergillosis, Aspergillus, Candida, Candidiasis, Humans, Drug Resistance, Fungal

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