Molecular Markers of Antifungal Resistance: Potential Uses in Routine Practice and Future Perspectives.

Guillermo Garcia-Effron

doi:10.3390/jof7030197

Abstract

Antifungal susceptibility testing (AST) has come to establish itself as a mandatory routine in clinical practice. At the same time, the mycological diagnosis seems to have headed in the direction of non-culture-based methodologies. The downside of these developments is that the strains that cause these infections are not able to be studied for their sensitivity to antifungals. Therefore, at present, the mycological diagnosis is correctly based on laboratory evidence, but the antifungal treatment is undergoing a growing tendency to revert back to being empirical, as it was in the last century. One of the explored options to circumvent these problems is to couple non-cultured based diagnostics with molecular-based detection of intrinsically resistant organisms and the identification of molecular mechanisms of resistance (secondary resistance). The aim of this work is to review the available molecular tools for antifungal resistance detection, their limitations, and their advantages. A comprehensive description of commercially available and in-house methods is included. In addition, gaps in the development of these molecular technologies are discussed.

Highlights

Antifungal susceptibility testing is an essential tool in different clinical scenarios.Standardized protocols (from the Clinical and Laboratory Standards Institute (CLSI)and from the European Committee on Antimicrobial Susceptibility Testing (EUCAST)) and commercially available methods are able to detect resistant fungal strains, to guide antifungal therapies, and to offer reliable epidemiological data on antifungal resistance [1]
When these methodologies seemed to have come to establish themselves as a mandatory routine in any clinical microbiology laboratory, the mycological diagnosis seems to have headed in the direction of non-culture-based methodologies
With good sensitivity and speed [4]. The downside of these developments is that the strains that cause these infections are not available to study their sensitivity to antifungals

Summary

Introduction

Standardized protocols (from the Clinical and Laboratory Standards Institute (CLSI)and from the European Committee on Antimicrobial Susceptibility Testing (EUCAST)) and commercially available methods (some of them automated) are able to detect resistant fungal strains, to guide antifungal therapies, and to offer reliable epidemiological data on antifungal resistance [1]. When these methodologies seemed to have come to establish themselves as a mandatory routine in any clinical microbiology laboratory, the mycological diagnosis seems to have headed in the direction of non-culture-based methodologies. The downside of these developments is that the strains that cause these infections are not available to study their sensitivity to antifungals

Objectives

Methods

Conclusion