Antifungal resistance is an important cause of treatment failure. For detailed reviews of the mechanisms underlying resistance please see Perlin et al (2017), Cowen et al (2015) or Revie et al (2018).
Breakpoints & susceptibility testing
Resistance can be either MICROBIOLOGICAL (presence of a resistance mutation) or CLINICAL (treatment failure).
Candida auris is an emerging pathogen with intrinsic multiple drug resistance (MDR) and nosocomial transmission.
Empirical antifungal therapy and prophylaxis save lives, but are associated with the development of antifungal resistance.
The cornerstones of an antifungal stewardship programme are:
- Rapid diagnostics, including susceptibility testing
- Targeted (i.e. not empirical) prescribing of antifungals