Antifungal drug resistance among Candida species: mechanisms and clinical impact

Sanguinetti, Maurizio; Posteraro, Brunella; Lass‐Flörl, Cornelia

doi:10.1111/myc.12330

Cited by 394Antifungal resistance and susceptibilityFungal Plant Pathogen ControlYeasts and Rust Fungi Studies

Antifungal drug resistance among Candida species: mechanisms and clinical impact

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Sanguinetti, Maurizio, Posteraro, Brunella, Lass‐Flörl, Cornelia·2015·Mycoses

DOI 10.1111/myc.12330

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Abstract

The epidemiology of Candida infections has changed in recent years. Although Candida albicans is still the main cause of invasive candidiasis in most clinical settings, a substantial proportion of patients is now infected with non-albicans Candida species. The various Candida species vary in their susceptibility to the most commonly used antifungal agents, and the intrinsic resistance to antifungal therapy seen in some species, along with the development of acquired resistance during treatment in others, is becoming a major problem in the management of Candida infection. A better understanding of the mechanisms and clinical impact of antifungal drug resistance is essential for the efficient treatment of patients with Candida infection and for improving treatment outcomes. Herein, we report resistance to the azoles and echinocandins among Candida species.

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Species more tolerant to echinocandins include C. parapsilosis, C. orthopsilosis, C. metapsilosis, C. guillerimondii, C. lipolytica, and C. fermentati.
“Among the species more tolerant to echinocandins, besides C. parapsilosis, we can find C. orthopsilosis, C. metapsilosis, C. guillerimondii, C. lipolytica, and C. fermentati [33,34,35].”
From Evolutionary Emergence of Drug Resistance in Candida Opportunistic Pathogens (2018) · cites this paper as [33]
C. glabrata and C. krusei have a naturally low susceptibility to azoles, while C. parapsilosis strains tend to have a lower susceptibility to echinocandins.
“For instance, C. glabrata and C. krusei have a naturally low susceptibility to azoles, while C. parapsilosis strains tend to have a lower susceptibility to echinocandins [33].”
From Evolutionary Emergence of Drug Resistance in Candida Opportunistic Pathogens (2018) · cites this paper as [33]
Species naturally more tolerant to azoles include C. glabrata, C. krusei, and less common species such as C. ciferrii, C. guilliermondii, C. inconspicua, C. humicola, C. lambica, C. lipolytica, C. norvegensis, C. palmioleophila, C. rugosa, and C. valida.
“Species naturally more tolerant to azoles include the above mentioned C. glabrata and C. krusei, as well as a long list of less common species such as C. ciferrii, C. guilliermondii, C. inconspicua, C. humicola, C. lambica, C. lipolytica, C. norvegensis, C. palmioleophila, C. rugosa, and C. valida.”
From Evolutionary Emergence of Drug Resistance in Candida Opportunistic Pathogens (2018) · cites this paper as [33]
In contrast to other species, azole resistance in C. glabrata is generally not associated with alteration in ERG11, but rather with mutations in the PDR1 transcription factor that cause differential expression of downstream targets.
“In contrast to other species, azole resistance in C. glabrata is generally not associated with alteration in ERG11 [33,63,96,97], but rather with mutations in the PDR1 transcription factor, which cause the differential expression of downstream targets [97].”
From Evolutionary Emergence of Drug Resistance in Candida Opportunistic Pathogens (2018) · cites this paper as [33]
11.1%-58.3% of C. glabrata isolates resistant to echinocandins had cross resistance against fluconazole or other azoles.
“As a result, 11.1%–58.3% of C. glabrata isolates resistant to echinocandins had cross resistance against fluconazole or other azoles [168,169,172]”
From Candida glabrata Biofilms: How Far Have We Come? (2017) · cites this paper as [172]

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Research works printed but not linked: 3

Chow JK, Golan Y, Ruthazer R, et al. Factors associated with candi- demia caused by non-albicans Candida species versus Candida albicans in the intensive care unit. Clin Infect Dis 2008; 46: 1206-13.
Lackner M, Tscherner M, Schaller M, et al. Position and numbers of FKS mutations in C. albicans selectively influence in vitro and in vivo susceptibility to echinocandin treatment. Antimicrob Agents Chemother 2014; 58: 3626-35.
Parmeland L, Gazon M, Guerin C, et al. Candida albicans and non- Candida albicans fungemia in an institutional hospital during a dec- ade. Med Mycol 2013; 51: 33-37. 122

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Authors: Sanguinetti, M., Posteraro, B., & Lass‐Flörl, C.
Affiliations: Università Cattolica del Sacro Cuore (IT)
Innsbruck Medical University (AT)
Corresponding author: Posteraro, Brunella
ORCID: Sanguinetti, Maurizio
Posteraro, Brunella
Lass‐Flörl, Cornelia
Venue: Mycoses
Publisher: Wiley
Published: 2015-05-29
Volume: 58
Issue: S2
Pages: 2-13
ISSN: 0027-5557 (ISSN-L)
0933-7407
1439-0507
DOI: 10.1111/myc.12330
OpenAlex: W1716405613
Cited by: 394
References: 133
Citations by year: 2026: 15 · 2025: 27 · 2024: 32 · 2023: 42 · 2022: 37 · 2021: 45 · 2020: 40 · 2019: 53 · 2018: 39 · 2017: 38 · 2016: 23 · 2015: 3
FWCI: 5.17
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Mycoses (publishedVersion)
PubMed (publishedVersion)
Funders: Pfizer
Topics: Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
Life Sciences › Agricultural and Biological Sciences › Ecology, Evolution, Behavior and Systematics › Fungal Plant Pathogen Control
Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Yeasts and Rust Fungi Studies
Keywords: antifungal resistance, Candida, Candida albicans, non-albicans Candida, invasive candidiasis, azole resistance, echinocandin resistance, acquired resistance, intrinsic resistance, antifungal susceptibility
MeSH terms: Antifungal Agents, Azoles, Candida, Candidiasis, Humans, Drug Resistance, Fungal, Echinocandins

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Antifungal drug resistance among Candida species: mechanisms and clinical impact

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