Use of novel tools to probe drug resistance in Fungi

Antifungal drug resistance threatens therapeutic effectiveness and needs to be diagnosed in a timely manner. Currently, recognition of antifungal resistance still relies on culture-based susceptibility testing. Yet, antifungal susceptibility testing is not routinely performed and often comes too late to influence a timely decision on patient management. With the quantum leap of molecular technology and accrued insights on basic fungal cell biology and antifungal drug resistance mechanisms, some novel molecular techniques are now available to provide a faster and more accurate assessment of both primary and secondary resistance than classical methodologies. Validated targets for echinocandin resistance in Candida spp. and triazole resistance in Aspergillus fumigatus and Candida spp. are particularly well suited for molecular detection. Yet, implementation of a molecular diagnosis for drug resistance into the clinical settings requires validation in well-designed clinical trials, as well as improved methods for highly efficient primary sample preparation.