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Review
. 2024 Jan 29;13(2):128.
doi: 10.3390/pathogens13020128.

Antifungal Resistance in Cryptococcal Infections

Marcia S C Melhem  1   2   3 , Diniz Pereira Leite Júnior  1 , Juliana P F Takahashi  2   4 , Milena Bronze Macioni  1 , Lidiane de Oliveira  5 , Lisandra Siufi de Araújo  2   6 , Wellington S Fava  2 , Lucas X Bonfietti  6 , Anamaria M M Paniago  2 , James Venturini  2 , Ana Espinel-Ingroff  7   8
Affiliations
Review

Antifungal Resistance in Cryptococcal Infections

Marcia S C Melhem et al. Pathogens. .

Abstract

Antifungal therapy, especially with the azoles, could promote the incidence of less susceptible isolates of Cryptococcus neoformans and C. gattii species complexes (SC), mostly in developing countries. Given that these species affect mostly the immunocompromised host, the infections are severe and difficult to treat. This review encompasses the following topics: 1. infecting species and their virulence, 2. treatment, 3. antifungal susceptibility methods and available categorical endpoints, 4. genetic mechanisms of resistance, 5. clinical resistance, 6. fluconazole minimal inhibitory concentrations (MICs), clinical outcome, 7. environmental influences, and 8. the relevance of host factors, including pharmacokinetic/pharmacodynamic (PK/PD) parameters, in predicting the clinical outcome to therapy. As of now, epidemiologic cutoff endpoints (ECVs/ECOFFs) are the most reliable antifungal resistance detectors for these species, as only one clinical breakpoint (amphotericin B and C. neoformans VNI) is available.

Keywords: CLSI; EUCAST ECVs; amphotericin B; azoles; fluconazole; resistance.

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Conflict of interest statement

The authors declare no conflicts of interest.

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