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Analysis of Susceptibility and Drug Resistance of Antifungal Agents in Aspergillosis and Mucormycosis Patients: A Systematic Review

Summary

This comprehensive study analyzed how well five major antifungal drugs work against common disease-causing fungi like Aspergillus and Mucorales. Researchers reviewed 96 studies examining over 16,000 fungal samples to understand resistance patterns. The findings show that different fungi respond better to different drugs—for example, Aspergillus flavus responds well to voriconazole, while amphotericin B works best against other Aspergillus species. This information helps doctors choose the most effective treatments for fungal infections in vulnerable patients.

Background

Invasive fungal diseases, particularly aspergillosis and mucormycosis, are associated with high morbidity and mortality in immunocompromised patients. Over the past decade, increased antifungal use has led to emerging drug resistance in both clinical and environmental isolates. A comprehensive understanding of susceptibility and resistance patterns is essential for effective treatment.

Objective

To systematically evaluate and analyze the susceptibility and resistance of Aspergillus and Mucorales isolates to antifungal agents including amphotericin B, isavuconazole, itraconazole, posaconazole, and voriconazole. The study aims to provide clinicians with data to guide appropriate drug selection and dosing.

Results

A. flavus showed high susceptibility to voriconazole with normal MIC values, while amphotericin B, isavuconazole, and itraconazole had elevated MIC values. A. fumigatus and A. niger demonstrated high susceptibility to amphotericin B with normal MIC values, while other agents showed elevated MIC values. For Mucorales, resistance to amphotericin B was consistently lowest among all tested agents.

Conclusion

Trends in susceptibility and resistance of Aspergillus and Mucorales isolates should guide antifungal therapy decisions. Voriconazole is recommended for A. flavus infections, while amphotericin B remains most effective for A. fumigatus, A. niger, and Mucorales infections. Accurate detection of resistant isolates is crucial to avoid inappropriate treatment.
  • Published in:Mycoses,
  • Study Type:Systematic Review,
  • Source: 41108579, 10.1111/myc.70118
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