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      Emerging Threats in Antifungal-Resistant Fungal Pathogens

      review-article
      1 , *
      Frontiers in Medicine
      Frontiers Media S.A.
      antifungals, drug resistance, Candida, Aspergillus

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          Abstract

          The use of antifungal drugs in the therapy of fungal diseases can lead to the development of antifungal resistance. Resistance has been described for virtually all antifungal agents in diverse pathogens, including Candida and Aspergillus species. The majority of resistance mechanisms have also been elucidated at the molecular level in these pathogens. Drug resistance genes and genome mutations have been identified. Therapeutic choices are limited for the control of fungal diseases, and it is tempting to combine several drugs to achieve better therapeutic efficacy. In the recent years, several novel resistance patterns have been observed, including antifungal resistance originating from environmental sources in Aspergillus fumigatus and the emergence of simultaneous resistance to different antifungal classes (multidrug resistance) in different Candida species. This review will summarize these current trends.

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          Most cited references80

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          Prospective surveillance for invasive fungal infections in hematopoietic stem cell transplant recipients, 2001-2006: overview of the Transplant-Associated Infection Surveillance Network (TRANSNET) Database.

          The incidence and epidemiology of invasive fungal infections (IFIs), a leading cause of death among hematopoeitic stem cell transplant (HSCT) recipients, are derived mainly from single-institution retrospective studies. The Transplant Associated Infections Surveillance Network, a network of 23 US transplant centers, prospectively enrolled HSCT recipients with proven and probable IFIs occurring between March 2001 and March 2006. We collected denominator data on all HSCTs preformed at each site and clinical, diagnostic, and outcome information for each IFI case. To estimate trends in IFI, we calculated the 12-month cumulative incidence among 9 sequential subcohorts. We identified 983 IFIs among 875 HSCT recipients. The median age of the patients was 49 years; 60% were male. Invasive aspergillosis (43%), invasive candidiasis (28%), and zygomycosis (8%) were the most common IFIs. Fifty-nine percent and 61% of IFIs were recognized within 60 days of neutropenia and graft-versus-host disease, respectively. Median onset of candidiasis and aspergillosis after HSCT was 61 days and 99 days, respectively. Within a cohort of 16,200 HSCT recipients who received their first transplants between March 2001 and September 2005 and were followed up through March 2006, we identified 718 IFIs in 639 persons. Twelve-month cumulative incidences, based on the first IFI, were 7.7 cases per 100 transplants for matched unrelated allogeneic, 8.1 cases per 100 transplants for mismatched-related allogeneic, 5.8 cases per 100 transplants for matched-related allogeneic, and 1.2 cases per 100 transplants for autologous HSCT. In this national prospective surveillance study of IFIs in HSCT recipients, the cumulative incidence was highest for aspergillosis, followed by candidiasis. Understanding the epidemiologic trends and burden of IFIs may lead to improved management strategies and study design.
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            Infectious Disease. How to bolster the antifungal pipeline.

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              Candida biofilms: an update.

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                Author and article information

                Contributors
                URI : http://frontiersin.org/people/u/29935
                Journal
                Front Med (Lausanne)
                Front Med (Lausanne)
                Front. Med.
                Frontiers in Medicine
                Frontiers Media S.A.
                2296-858X
                15 March 2016
                2016
                : 3
                : 11
                Affiliations
                [1] 1Institute of Microbiology, University Hospital Center, University of Lausanne , Lausanne, Switzerland
                Author notes

                Edited by: Yuji Morita, Aichi Gakuin University, Japan

                Reviewed by: Miguel Cacho Teixeira, University of Lisbon, Portugal; Mikhail Keniya, University of Otago, New Zealand

                *Correspondence: Dominique Sanglard, dominique.sanglard@ 123456chuv.ch

                Specialty section: This article was submitted to Infectious Diseases, a section of the journal Frontiers in Medicine

                Article
                10.3389/fmed.2016.00011
                4791369
                27014694
                919c5a38-26c8-4867-ab39-aced1b245be0
                Copyright © 2016 Sanglard.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 16 January 2016
                : 03 March 2016
                Page count
                Figures: 1, Tables: 1, Equations: 0, References: 101, Pages: 10, Words: 8482
                Funding
                Funded by: Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung 10.13039/501100001711
                Award ID: 31003A_146936, CRSII3_141848
                Categories
                Medicine
                Review

                antifungals,drug resistance,candida,aspergillus
                antifungals, drug resistance, candida, aspergillus

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