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Abstract
After the 1980s, the fungal infection rate increased significantly due to the widespread use of antibiotics, corticosteroids, cytostatic and immunosuppressive agents, becoming a frequent problem difficult to manage, especially in intensive care units. Currently, there is a wide range of antifungal antibiotics generally classified after the action mechanism, as follows: antifungal antibiotics interfering with the sterol synthesis path from the cell membrane - azoles (e.g. clotrimazole, fluconazole, voriconazole); allylamines (e.g. naphtifine, terbinafine); polyenes (e.g. amphotericin B, nystatin); inhibitors of the synthesis of glucan fungal cell wall composition (e.g. caspofungin); antimetabolites (e.g. flucytosine); antifungals acting on the mitotic spindle (e.g. griseofulvin). In 1980, first cases of antifungal resistance were reported in patients with chronic muco-cutaneous candidiasis resistant to antifungal, who were following treatment with azoles. The phenomenon has intensified from 1990 along with the increasing incidence of fungal infections, and the diversity of etiological agents. The molecular mechanisms of resistance to antifungal agents are not fully understood, but resistance to a certain antifungal is a complex process involving factors of the microorganism (cellular and humoral) and factors regarding the host (the degree of immunosuppression, location and severity of the infection).
Keywords: fungi, antifungals, resistence mechanisms
Rezumat
Dupa anii 1980, incidenta infectiilor fungice a crescut considerabil ca urmare a utilizarii pe scara larga a antibioticelor, corticosteroizilor, citostaticelorsi medicamentelor imunosupresoare, devenind o problema frecventa si dificil de gestionat mai ales în sectiile de terapie intensiva.
În prezent, exista o gama variata de antibiotice antifungice clasificate, în general, dupa modul de actiune, dupa cum urmeaza: antibiotice antifungice cu actiune la nivelul cailor de sinteza a sterolilor din membrana celulara - azoli (de exemplu, clotrimazol, fluconazol, voriconazol); alilamine (de exemplu, naftifin, terbinafin); poliene (de exemplu, amfotericina B, nistatin); inhibitorii sintezei glucanului din compozitia peretelui celular fungic (de exemplu, caspofungin); antimetaboliti (de exemplu, flucitozina); antifungice care actioneaza la nivelul fusului mitotic (de exemplu, griseofulvina).
În 1980 au fost semnalate primele cazuri de rezistentä la antifungice lapacienti cu candidoze mucocutanate cronice, aflati sub tratament cu azoli. Fenomenul a luat amploare din anii 1990, odata cu cresterea atât a incidentei infectiilor fungice, cât si a diversitatii agentilor etiologici. Înca nu se cunoscpe deplin mecanismele moleculare ale rezistentei la antifungice, însa rezistenta la un anumit antifungic este un proces complex, care...