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Antifungal Resistance: A Growing Concern
Resistencia antifúngica: una creciente preocupación
DOI:
https://doi.org/10.15446/abc.v28n3.104736Palabras clave:
Antifungal Agents, Drug Resistance, Fungal, Invasive Fungal Infections, Mycoses, Public health (en)Antifúngicos, Farmacorresistencia Fúngica, Infecciones Fúngicas Invasoras, Micosis, Salud Pública (es)
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Globally, the increasing number of drug-resistant human pathogens represents a major threat to public health. Among these pathogens, fungi that have acquired resistance to the already scarce arsenal of antifungals are of particular significance, as they present therapeutic challenges that increase morbidity and mortality rates. Particularly, most mycoses are opportunistic since they mainly affect hosts with a weakened immune system, including patients with cancer, hematological malignancies, prolonged neutropenia, solid organ transplants, HIV/AIDS, patients in intensive care units, using central venous catheters or on dialysis, using corticosteroids, among others. In most cases, fungal infections have a significant medical and economic burden that outweighs the burden of the underlying disease alone and changes the outcome. In addition, the treatment for mycoses, which consists of four classes of antifungals described several decades ago, polyenes, flucytosine, azoles, and echinocandins, continues to be a major challenge. With the increase in patients at risk, the incidence of mycoses is therefore a growing concern. Considering as well, the scarcity of drugs, together with toxicity, the high price of some formulations, the low availability in low-resource countries, and the development of resistance, there is an urgent need to discover new antifungals or therapeutic strategies or to modify the existing molecules with antifungal activity. This reflection article reveals that various of the most common human fungal pathogens have had the ability to acquire antifungal resistance as antifungal drugs are developed.
Mundialmente, el creciente número de patógenos humanos resistentes a fármacos representa una importante amenaza para la salud pública. Entre estos patógenos, los hongos que han adquirido resistencia al escaso arsenal de antifúngicos son de particular significancia, porque presentan desafíos terapéuticos que aumentan la morbilidad y mortalidad. Particularmente, la mayoría de las micosis son oportunistas porque afectan especialmente a huéspedes con un sistema inmunológico debilitado, incluyendo pacientes con cáncer, neoplasias hematológicas y neutropenia prolongada, trasplante de órganos sólidos, VIH/SIDA, pacientes en unidades de cuidado intensivo, usando catéteres venosos centrales o en diálisis, usando corticosteroides, entre otros. Generalmente, las infecciones fúngicas tienen una carga médica y económica significativa que supera la carga de la enfermedad subyacente por sí sola y modifica el panorama de su desenlace. Por otro lado, el tratamiento para las micosis, que consiste en cuatro clases de antifúngicos descritos ya hace varias décadas, polienos, flucitosina, azoles y equinocandinas, sigue siendo un desafío importante. Con el incremento de pacientes en riesgo, la incidencia de las micosis es entonces una preocupación creciente. Considerando además la escasez de fármacos, su toxicidad, el alto precio de algunas formulaciones, la poca disponibilidad en países de escasos recursos y el desarrollo de resistencia, existe una necesidad urgente de descubrir nuevos antifúngicos o estrategias terapéuticas o de modificar las moléculas existentes con actividad antimicótica. En este artículo de reflexión se revela que varios de los hongos patógenos humanos más comunes han tenido la capacidad de adquirir resistencia antifúngica a medida que se desarrollan drogas antifúngicas.
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