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Antifungal resistance and susceptibility
Research Guide
What is Antifungal resistance and susceptibility?
Antifungal resistance is the ability of fungal pathogens to withstand the effects of antifungal drugs, while antifungal susceptibility refers to the sensitivity of fungi to these agents, critical for guiding effective treatment in invasive fungal infections.
There are 116,406 works on antifungal resistance and susceptibility, reflecting extensive research into fungal pathogens affecting humans. Invasive candidiasis remains a leading cause of mycosis-associated mortality in the United States, with stable associated mortality rates as reported by Pfaller and Diekema (2007). Revised definitions of invasive fungal disease by de Pauw et al. (2008) standardize diagnosis to support clinical trials and epidemiology.
Research Sub-Topics
Azole Resistance in Aspergillus fumigatus
This sub-topic examines the molecular mechanisms, genetic mutations like cyp51A alterations, and epidemiological spread of azole resistance in Aspergillus fumigatus, a leading cause of invasive aspergillosis. Researchers study environmental and clinical isolates to track resistance emergence and develop diagnostic tools.
Echinocandin Resistance in Candida glabrata
Focuses on fks gene mutations conferring echinocandin resistance in Candida glabrata, an emerging multidrug-resistant pathogen. Studies explore clinical outcomes, prevalence in bloodstream infections, and therapeutic alternatives.
Antifungal Susceptibility Testing Methods
Covers standardization of broth microdilution, disk diffusion, and EUCAST/CLSI methods for testing susceptibility of yeasts and molds to antifungals. Researchers validate new techniques like gradient strips and explore reproducibility across labs.
Biofilm-Associated Antifungal Resistance
Investigates reduced susceptibility in fungal biofilms, particularly Candida albicans and device-related infections, including matrix composition and persister cells. Research targets biofilm disruption strategies and combination therapies.
Epidemiology of Invasive Fungal Resistance
Analyzes global trends, risk factors, and outbreaks of antifungal resistance in invasive candidiasis, aspergillosis, and mucormycosis across hospitals. Studies use genomic surveillance to map transmission dynamics.
Why It Matters
Antifungal resistance complicates treatment of invasive infections like candidiasis and aspergillosis, where mortality remains high despite therapies. Pfaller and Diekema (2007) documented invasive candidiasis as a persistent public health problem with stable mortality in the US. Herbrecht et al. (2002) showed voriconazole achieved better responses and survival than amphotericin B in invasive aspergillosis, reducing severe side effects. Guidelines by Pappas et al. (2016, 2009) and Freifeld et al. (2011) direct antifungal use in candidiasis and neutropenic cancer patients, emphasizing susceptibility testing. Recent preprints like "FungAMR: a comprehensive database for investigating fungal mutations associated with antimicrobial resistance" (2025) curate 501 studies to track resistance mutations, aiding surveillance.
Reading Guide
Where to Start
"Revised Definitions of Invasive Fungal Disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group" by de Pauw et al. (2008), as it establishes foundational diagnostic criteria essential for understanding resistance and susceptibility in research.
Key Papers Explained
De Pauw et al. (2008) provide diagnostic definitions building the framework for studies like Pfaller and Diekema (2007), who detail candidiasis epidemiology using those criteria. Pappas et al. (2009, 2016) extend this into management guidelines incorporating susceptibility data from Pfaller. Herbrecht et al. (2002) demonstrate voriconazole's superiority, informing guideline updates.
Paper Timeline
Most-cited paper highlighted in red. Papers ordered chronologically.
Advanced Directions
Preprints like "FungAMR: a comprehensive database for investigating fungal mutations associated with antimicrobial resistance" (2025) and "Collectively charting the landscape of antifungal and fungicide resistance" (2025) curate mutation data from 501 studies for genomic surveillance. News on SCY-247's FDA QIDP designation (2026) and dSHERLOCK diagnostics for Candida auris resistance highlight tools for rapid testing.
Papers at a Glance
In the News
Antifungal Earns FDA QIDP and Fast Track Designations ...
Scynexis has secured FDA Qualified Infectious Disease Product (QIDP) and Fast Track designations for its next-generation antifungal SCY-247, underscoring the drug’s potential to address the escalat...
Digital CRISPR-based diagnostics for quantification of Candida auris and resistance mutations
*Candida auris*, an increasingly prevalent fungal pathogen, requires both rapid identification and antifungal susceptibility testing to enable proper treatment. This study introduces digital SHERLO...
Innovative antifungal strategies to combat drug-resistant Candida auris: recent advances and clinical implications
Front Cell Infect Microbiol . 2025 Jul 31;15:1641373. doi: 10.3389/fcimb.2025.1641373 # Innovative antifungal strategies to combat drug-resistant _Candida auris_: recent advances and clinical im...
FungAMR: a comprehensive database for investigating fungal mutations associated with antimicrobial resistance
Antimicrobial resistance (AMR) is a global threat, especially in fungal pathogens. To optimize the use of available antifungals, we need rapid detection and monitoring tools that rely on high-quali...
Research Initiatives on Antimicrobial Resistance | NIAID
initiatives.)
Code & Tools
## Repository files navigation # Development of a framework for identification of Candida species and detection of antifungal resistance
**AMRgen**is an open-source R package designed to**bridge the gap between genotypic and phenotypic antimicrobial resistance (AMR) data**. Developed...
Our goal is to develop interpretive standards for AMR genotypes, akin to the interpretive standards developed by EUCAST and CLSI for antimicrobial ...
This software was created by the WHONET development team to facilitate the interpretation of antibiotic measurements according to the published gui...
The`AMR`package is a peer-reviewed, free and open-source R package with zero dependencies to simplify the analysis and prediction of Antimicrobial ...
Recent Preprints
FungAMR: a comprehensive database for investigating fungal mutations associated with antimicrobial resistance
Antimicrobial resistance (AMR) is a global threat, especially in fungal pathogens. To optimize the use of available antifungals, we need rapid detection and monitoring tools that rely on high-quali...
Collectively charting the landscape of antifungal and fungicide resistance
Better knowledge of which fungal mutations give rise to antimicrobial resistance and by which mechanisms is key to improving treatment strategies and drug development. We assembled a comprehensive ...
Candida auris skin tropism and antifungal resistance are mediated by carbonic anhydrase Nce103
The pronounced skin tropism and pan-antifungal resistance of*Candida auris*pose a serious global health threat. A key question in*C. auris*biology is how clinical isolates acquire amphotericin B re...
Antifungal and fungicide susceptibility of clinical, animal ...
*Fusarium*and*Neocosmospora*are widely recognized genera pathogenic to humans, animals, and plants. While the resistance of clinical and environmental strains to antifungal drugs and fungicide agen...
Antifungal Resistance Surveillance: Insights From National ...
Fungal pathogens and the infections they cause are notoriously understudied and underrepresented in public health surveillance programs. Recent initiatives, such as that of the Joint Programming In...
Latest Developments
Recent research has identified a new weakness in deadly fungi using butyrolactol A, which can weaken fungi and restore the effectiveness of existing antifungal drugs (ScienceDaily, 01/22/2026). Additionally, a compound has been found that sensitizes fungal pathogens to the antifungal drug caspofungin, potentially overcoming drug resistance (Nature Reviews Microbiology, 01/22/2026). Other developments include the discovery of potent activity of second-generation fungers and the ongoing clinical milestones for new antifungal agents like SCY-247 (SCYNEXIS, 01/28/2026), and increased understanding of rising antifungal resistance in species such as Trichophyton (Frontiers, 01/26/2026). Overall, the field is advancing with new molecular targets, compounds, and a better understanding of resistance mechanisms (Nature Microbiology, 10/29/2024).
Sources
Frequently Asked Questions
What are the revised definitions of invasive fungal disease?
De Pauw et al. (2008) in "Revised Definitions of Invasive Fungal Disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group" provide standardized criteria for proven, probable, and possible invasive fungal disease. These definitions advance clinical and epidemiological research in high-risk patients. They serve as a model for defining other infections.
How does voriconazole compare to amphotericin B in invasive aspergillosis?
Herbrecht et al. (2002) in "Voriconazole versus Amphotericin B for Primary Therapy of Invasive Aspergillosis" found voriconazole led to better responses, improved survival, and fewer severe side effects. This established voriconazole as superior initial therapy. The study involved patients with confirmed invasive aspergillosis.
What is the epidemiology of invasive candidiasis?
Pfaller and Diekema (2007) in "Epidemiology of Invasive Candidiasis: a Persistent Public Health Problem" report it as a leading cause of mycosis-associated mortality in the US. Mortality rates have remained stable based on National Center for Health Statistics data. The review updates incidence and risk factors.
What guidelines exist for managing candidiasis?
Pappas et al. (2016) in "Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America" and Pappas et al. (2009) in "Clinical Practice Guidelines for the Management Candidiasis: 2009 Update by the Infectious Diseases Society of America" provide evidence-based recommendations. These cover invasive and mucosal candidiasis, stressing individualized care. Adherence is voluntary per IDSA.
What challenges exist in treating invasive fungal infections?
Brown et al. (2012) in "Hidden Killers: Human Fungal Infections" highlight lack of robust rapid diagnostics, safe drugs, and vaccines. Fungal diseases kill over 1.5 million annually per Bongomin et al. (2017). Most deaths are avoidable with better tools.
Open Research Questions
- ? What specific mutations confer pan-antifungal resistance in Candida auris, as mediated by carbonic anhydrase Nce103?
- ? How can comprehensive datasets of fungal resistance mutations improve drug development and treatment strategies?
- ? What surveillance gaps exist in fungal antifungal resistance, and how can networks like JPIAMR address them?
- ? Which One Health susceptibility profiles distinguish clinical, animal, and environmental Fusarium and Neocosmospora strains?
- ? How do mitochondrial energy functions modulated by carbonic sensing pathways contribute to amphotericin B resistance?
Recent Trends
Preprints from 2025 introduce FungAMR curating 501 studies on AMR mutations and datasets charting resistance landscapes across species.
Candida auris research shows carbonic anhydrase Nce103 mediates skin tropism and amphotericin B resistance.
Surveillance initiatives via JPIAMR address underrepresentation, with One Health studies on Fusarium susceptibility.
News covers FDA Fast Track for SCY-247 and CRISPR diagnostics for auris.
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