Antifungal resistance

Antifungal resistance is the ability of a fungus to survive exposure to a drug that would ordinarily inhibit or kill it. It can arise through genetic change or selection of resistant strains.

Ergosterol: A sterol that stabilizes fungal cell membranes and is targeted by several antifungal drugs. Changes in ergosterol production or structure can reduce susceptibility to membrane-targeting drugs.
Natural selection: The process by which heritable traits that improve survival or reproduction become more common in a population. Antifungal exposure favors fungal variants that can withstand the drug.
Antifungal susceptibility testing: Laboratory testing that measures how fungal isolates respond to antifungal drugs. Testing helps identify drugs that may remain active against a resistant isolate.
Antifungal tolerance: The ability of a fungal population to grow slowly or survive prolonged drug exposure without a stable increase in its minimum inhibitory concentration. Tolerance can prolong survival during treatment without meeting the usual definition of resistance.
Candida auris: A pathogenic yeast that can spread in healthcare settings and is often resistant to multiple antifungal drugs. This emerging pathogen exemplifies the clinical burden of multidrug resistance.
Efflux pump: A membrane protein that transports substances, including drugs, out of a cell. Overactive fungal efflux pumps can lower intracellular concentrations of antifungal drugs.
Mutation: A change in the DNA sequence of an organism. Mutations can produce traits that reduce susceptibility to an antifungal drug.
Antifungal stewardship: The coordinated use of antifungal drugs to improve treatment while limiting unnecessary exposure. Stewardship reduces avoidable selection pressure and supports appropriate therapy.
Antifungal persistence: Survival of a small, transiently drug-tolerant subpopulation within an otherwise susceptible microbial population. Persister cells survive treatment without necessarily carrying heritable resistance.
Candida glabrata: A yeast species that causes human infections and can have reduced susceptibility to azole drugs. Its reduced azole susceptibility complicates treatment of some Candida infections.

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