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Chapter 16 : Drug Resistance in : Epidemiology and Molecular Mechanisms

Authors: M. A. Pfaller1, J. K. Lodge2, M. A. Ghannoum3
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Affiliations: 1: Departments of Pathology and Epidemiology, University of Iowa College of Medicine and College of Public Health, Iowa City, IA 52242–1009; 2: Department of Molecular Microbiology, Washington University of School of Medicine, St. Louis, MO 63110; 3: Center for Medical Mycology, Case Western Reserve University, Cleveland, OH 44106
Content Type: Monograph
Publication Year: 2011

Category: Clinical Microbiology; Fungi and Fungal Pathogenesis

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Abstract:

This chapter describes the epidemiology of antifungal drug resistance as identified by in vitro susceptibility testing and studies of the mechanisms of resistance in and . Taking into consideration the MIC distribution profiles for the various antifungal agents, the pharmacology of the antifungal drugs, and studies of resistance mechanisms and clinical outcomes, it is reasonable to adapt the breakpoints developed by the Clinical and Laboratory Standards Institute (CLSI) for spp. for use in the discussion of antifungal resistance in and . Resistance to flucytosine may develop from decreased uptake (loss of permease activity) or loss of enzymatic activity required for the conversion of flucytosine to 5-fluorouracil (cytosine deaminase) and 5-fluorouridylic acid (FUMP pyrophosphorylase). The echinocandin class of antifungals is relatively ineffective against sp., but the mechanism of this resistance is still unknown. The epidemiology of antifungal resistance in the pathogenic cryptococci is a dynamic process that differs considerably according to the status of health care, especially that devoted to HIV and AIDS, in the region of interest. Improved understanding of the mechanisms of antifungal resistance in cryptococci will ultimately help in the battle against emerging resistance.

Citation: Pfaller M, Lodge J, Ghannoum M. 2011. Drug Resistance in : Epidemiology and Molecular Mechanisms, p 203-216. In Heitman J, Kozel T, Kwon-Chung K, Perfect J, Casadevall A (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555816858.ch16
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Tables

Drug Resistance in Cryptococcus: Epidemiology and Molecular Mechanisms
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Citation: Pfaller M, Lodge J, Ghannoum M. 2011. Drug Resistance in : Epidemiology and Molecular Mechanisms, p 203-216. In Heitman J, Kozel T, Kwon-Chung K, Perfect J, Casadevall A (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555816858.ch16
/content/10.1128/9781555816858.ch16.ch16table01
TABLE 1
In vitro susceptibility changes to fluconazole in serial isolates of
Generic image for table
TABLE 1

In vitro susceptibility changes to fluconazole in serial isolates of

Citation: Pfaller M, Lodge J, Ghannoum M. 2011. Drug Resistance in : Epidemiology and Molecular Mechanisms, p 203-216. In Heitman J, Kozel T, Kwon-Chung K, Perfect J, Casadevall A (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555816858.ch16
/content/10.1128/9781555816858.ch16.ch16table02
TABLE 2
In vitro susceptibility of and to systemically active antifungal agents determined by CLSI M27-A3 BMD methods
Generic image for table
TABLE 2

In vitro susceptibility of and to systemically active antifungal agents determined by CLSI M27-A3 BMD methods

Citation: Pfaller M, Lodge J, Ghannoum M. 2011. Drug Resistance in : Epidemiology and Molecular Mechanisms, p 203-216. In Heitman J, Kozel T, Kwon-Chung K, Perfect J, Casadevall A (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555816858.ch16
/content/10.1128/9781555816858.ch16.ch16table03
TABLE 3
Fluconazole susceptibility of over time and by geographic region: ARTEMIS DISK Global Antifungal Surveillance Study, 2001–2007
Generic image for table
TABLE 3

Fluconazole susceptibility of over time and by geographic region: ARTEMIS DISK Global Antifungal Surveillance Study, 2001–2007

Citation: Pfaller M, Lodge J, Ghannoum M. 2011. Drug Resistance in : Epidemiology and Molecular Mechanisms, p 203-216. In Heitman J, Kozel T, Kwon-Chung K, Perfect J, Casadevall A (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555816858.ch16
/content/10.1128/9781555816858.ch16.ch16table04
TABLE 4
Temporal and geographic variation in the in vitro susceptibilities of isolates to systemically active antifungal agents
Generic image for table
TABLE 4

Temporal and geographic variation in the in vitro susceptibilities of isolates to systemically active antifungal agents

Citation: Pfaller M, Lodge J, Ghannoum M. 2011. Drug Resistance in : Epidemiology and Molecular Mechanisms, p 203-216. In Heitman J, Kozel T, Kwon-Chung K, Perfect J, Casadevall A (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555816858.ch16
/content/10.1128/9781555816858.ch16.ch16table05
TABLE 5
Temporal and geographic variation in the in vitro susceptibility of to systemically active antifungal agents
Generic image for table
TABLE 5

Temporal and geographic variation in the in vitro susceptibility of to systemically active antifungal agents

Citation: Pfaller M, Lodge J, Ghannoum M. 2011. Drug Resistance in : Epidemiology and Molecular Mechanisms, p 203-216. In Heitman J, Kozel T, Kwon-Chung K, Perfect J, Casadevall A (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555816858.ch16
/content/10.1128/9781555816858.ch16.ch16table06
TABLE 6
Mechanisms involved in the development of resistance to antifungal agents in
Generic image for table
TABLE 6

Mechanisms involved in the development of resistance to antifungal agents in

Citation: Pfaller M, Lodge J, Ghannoum M. 2011. Drug Resistance in : Epidemiology and Molecular Mechanisms, p 203-216. In Heitman J, Kozel T, Kwon-Chung K, Perfect J, Casadevall A (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555816858.ch16

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