Resistance to antifungal agents

The marked increase in the number of patients with AIDS and other forms of immunocompromise has resulted in the emergence of fungi as predominant pathogens in many institutions. Unfortunately, with the widespread use of antifungal agents to combat these infections, reports of resistance to antifungal agents have proliferated. In the present environment, the occurrence of resistance to antifungal agents is neither rare nor of negligible clinical importance. The expanding demand for antifungal agents mandates a new sense of vigilance for resistance. Although newly proposed standards for in vitro susceptibility testing should help to remove the ambiguity surrounding quantitative measurement of fungal resistance, lessons learned in the treatment of bacteria clearly now apply to fungi also: prolonged use of an antimicrobial agent will result in the selection of resistant organisms. The enlarging spectrum of resistance to antifungal agents must prompt aggressive searches for new modes of therapy. Strategies to inhibit fungal colonization, to augment host defenses, or to develop novel antifungal agents from Pseudomonas syringae⁶³ or from peptide nanotubes³⁸ are helping to solve this pressing clinical need.