ANTIFUNGAL RESISTANCE: A GROWING CONCERN

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.