About this Research Topic

Background

Invasive fungal infections (IFI) remain a major source of global morbidity and mortality, especially in immunocompromised patients with underlying diseases. Treatment of IFI is challenging as systematically available antifungal agents are currently limited to a few chemical classes. As a consequence, antifungal drug resistance, both acquired resistance and selection of intrinsically resistant species, has quickly emerged and become a significant concern to clinicians. Although we have general knowledge on the mechanisms that confer resistance to major drug classes in limited fungal species, deeper and more comprehensive understanding on this topic is needed and essential for developing rapid molecular diagnostics to capture drug resistance and for identification of novel targets for new drug development.

Despite advances achieved in detection of fungal pathogens, current methods for the diagnosis of IFI are largely culture-dependent. Therefore, pathogen identification often lags behind the initiation of empiric antifungal treatment, which may contribute to resistance development. Antifungal resistance, the second tier of the diagnosis of IFI, is determined by susceptibility testing per CLSI or EUCAST standards. However, there lacks definite association between phenotypic antifungal resistance, as defined by elevated minimum inhibitory concentrations (MIC), and clinical outcomes in infected patient population. This provides the rationale of developing molecular diagnostic methods that detect genes or mutations conferring resistance with much higher speed and accuracy compared to standard MIC determination test. In addition to rapid diagnostics and appropriate antifungal stewardship, new antifungal therapeutic strategies are of critical need to prevent resistance and improve treatment. This would certainly include new drugs with novel mechanisms of action against new targets, combination therapy of conventional antifungals, as well as repurposing of drugs that are of potential to eliminate resistance. Under the current Research Topic, we welcome promising and novel studies that focus on antifungal resistance and new therapeutic strategies. We seek Original Research articles, Technology Reports, Reviews, Brief Research Report, and Mini Reviews that cover, but are not limited to, the following areas:

• Epidemiology of drug resistant fungal infections
• Increase of antifungal drug resistance in specific settings (Hospitals, Nationwide surveys, etc)
• Novel mechanisms of antifungal resistance
• Rapid detection of antifungal resistance
• Novel targets and new antifungal agents
• Combination therapy of conventional antifungals and Repurposing of old drugs to combat resistant fungal infections

Keywords: Antifungal resistance, Epidemiology, Mechanism, Rapid detection, therapeutic strategies

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

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