Our understanding of the mechanisms of antifungal resistance lags far behind our knowledge of antibacterial resistance mechanisms. With the recognition of azole resistance, it has become apparent that several approaches used successfully in studying other eukaryotic and prokaryotic systems may be applicable to studying drug resistance in fungi. In each case, examples of specific resistance mechanisms have been found in clinical isolates of fungi. In fact, all of these mechanisms have been identified in one or another series of isolates of Candida obtained from patients failing azole therapy. Recognition of parallel resistance mechanisms in other cell systems may facilitate the study of antifungal resistance.
Additional work is necessary to further our understanding of antifungal drug resistance.
This knowledge will aid in our efforts to design new drugs and to control the spread of resistance. Recommendations Expand the development of molecular diagnostics for fungal infections. Encourage the use of nucleic acid probe and PCR-based methods for fungal detection and identification. Encourage studies of basic mechanisms of action and resistance to antifungal agents using experimental systems that incorporate both fungi and other eukaryotic microorganisms.