棘白菌素在念珠菌中的耐药性

摘要

Invasive candidiasis (IC) is an important concern for patients,especially immunocompromised patients.Antifungal therapy is critical for patient,but antifungals are limited.Antifungal resistance,particularly multidrug resistance aggravates this problem.The echinocandins which targeting fungal specific enzyme glucan synthase are the preferred choice to treat IC.The resistance rate of echinocandins has increased recently,and echinocandin resistant isolates are frequently resistant to other antifungals.The mechanism of echinocandin resistance involves amino acid changes of FKS,cellular processes and biofilms.The clinical factors that promote echinocandin resistance include prophylaxis,intra-abdominal candidiasis and host reservoirs.An understanding of the mechanisms and factors that promote echinocandin resistance is critical to develop better diagnostic tools and therapeutic strategies.%侵袭性念珠菌病(invasive candidiasis,IC)是住院患者特别是免疫力低下患者重要的感染性疾病.抗真菌药物治疗是最有效的处理方式,但抗真菌药物的种类非常有限,并已出现了多种药物耐药.棘白菌素类药物能够抑制真菌特有的葡聚糖合成酶,因此毒力低、临床疗效好,是治疗IC的一类关键药物.但近几年棘白菌素耐药有上升趋势,并常常表现为多重耐药,给临床治疗带来了巨大挑战.其耐药机制主要包括FKS突变、细胞压力应答、生物膜等.预防用药、腹腔念珠菌病、定植等是导致棘白菌素耐药的危险因素.了解念珠菌棘白菌素耐药的机制和危险因素对临床诊断和治疗决策的制定十分重要.