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A limited number of antifungal agents including azoles, polyenes, pyrimidine analogues are used today to combat infections caused by yeast pathogens. While clinical factors can contribute to failures to antifungal treatments, yeast pathogens exposed to these agents can still limit their action either because they are intrinsically resistant or because they acquire specific resistance mechanisms. Microbiological methods are available to measure the susceptibility of yeast pathogens against the existing antifungal agents and to distinguish between antifungal susceptible and antifungal resistant organisms. This distinction can ideally predict the success or failure of a treatment in clinical situations and is available only for a limited number of antifungal agents, i.e. the azole antifungals fluconazole and itraconazole and the pyrimidine analogue 5-fluorocytosine. Cases of antifungal resistance have been reported for almost all classes of antifungal agents, but they have been mainly documented for the pyrimidine analogue 5-fluorocytosine and azole antifungals mainly in Candida species and less frequently in Cryptococcus species. This review summarizes the current knowledge on the different mechanisms of resistance to these agents in these yeast pathogens.
En la actualidad se están empleando un número limitado de agentes antifúngicos, inluyendo azoles, polienos y análogos de pirimidinas, para combatir las infecciones causadas por levaduras patógenas. Ciertos factores clínicos pueden contribuir al fracaso del tratamiento antifúngico; por otra parte, las levaduras expuestas a estos agentes pueden limitar la actividad de los mismos, por ser intrínsecamente resistentes o por adquirir mecanismos de resistencia específicos. Se dispone de métodos microbiológicos para medir la sensibilidad de las levaduras patógenas a los antifúngicos disponibles, y para distinguir entre organismos sensibles y resistentes a los mismos. Esta distinción, de forma ideal, debiera predecir el éxito o el fracaso del tratamiento desde un punto de vista clínico, pero está disponible sólo para un número limitado de antifúnficos: los azoles, fluconazol e itraconazol, y el análogo de la pirimidina 5-fluorocitosina. Se han publicado casos de resistencia a los antifúngicos para casi todas las clases disponibles de estos agentes, pero sobre todo se han documentado en relación con la 5-fluorocitosina y los azoles en especies de Candida y, con menos frecuencia, en especies de Cryptococcus. En esta revisión se resume el conocimiento actual de los diferentes mecanismos de resistencia a los antifúngicos en levaduras patógenas.
Palabras clave:
Resistencia a antifúngicos
Candida
Cryptococcus
Key words:
Antifungal drug resistance
Candida
Cryptococcus
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