PDF(Pubmed)
Abstract：
Invasive candidiasis is a rising global health threat with increasing incidence, persistently high mortality, and diminishing treatment options. Antifungal resistance has rapidly emerged and spread, with multidrug-resistant species deemed an urgent and serious threat. While acknowledging the key role of antifungal stewardship and infection control in curbing spread, we examine the role of antifungal monotherapy in driving resistance and the potential for combination therapy to prevent stress adaptation and emergence of drug resistance. In addition to its role in mitigating resistance, combination treatment may improve drug penetration, expedite fungal clearance, and allow lower, less toxic doses of individual drugs to be used. A growing body of laboratory-based evidence suggests that antifungal combinations can yield synergistic activity against Candida spp., including against frequently multidrug-resistant Candida auris. It is imperative to test these combinations in clinical trials, incorporating resistance end points as a marker of success.
摘要：
侵袭性念珠菌病是一个不断上升的全球健康威胁，发病率不断上升。死亡率居高不下，和治疗选择的减少。抗真菌药物耐药性迅速出现并蔓延,多重耐药物种被认为是紧急和严重的威胁。在承认抗真菌管理和感染控制在遏制传播方面的关键作用的同时，我们研究了抗真菌单药治疗在驱动耐药性中的作用,以及联合治疗预防应激适应和耐药性出现的潜力.除了减轻抵抗力的作用外，联合治疗可以改善药物渗透，加速真菌清除，并允许更低，要使用的单个药物的毒性剂量较小。越来越多的基于实验室的证据表明，抗真菌组合可以对念珠菌产生协同活性。,包括针对多药耐药的耳念珠菌。必须在临床试验中测试这些组合，纳入阻力终点作为成功的标志。
