Candida auris Enfeksiyonlarının Tedavisi

Özge Özgen Top

doi:10.37609/akya.3202

Yazarlar

Özge Özgen Top

https://orcid.org/0000-0003-1468-4960

DOI: https://doi.org/10.37609/akya.3202.c12490

Özet

Candida auris, ciddi enfeksiyonlara neden olabilen ve birçok antifungal ilaç sınıfına dirençli olması nedeniyle çoklu ilaca dirençli (MDR) olarak sınıflandırılan bir Candida türüdür. İzolatların büyük bir kısmı flukonazol dirençli iken neredeyse yarısı 2 veya daha fazla antifungal ilaç grubuna dirençlidir. Flukonazole karşı sürekli yüksek minimum inhibitör konsantrasyon değerleri sergilerken diğer triazoller, ekinokandinler ve amfoterisin B’ye karşı değişken duyarlılık göstermektedir. Yaygın olarak kullanılan mevcut antifungal ajanlara karşı görülen bu yüksek orandaki direnç, tedavide zorluklara yol açabilmektedir. Birinci basamak tedavide ekinokandinler önerilse de ekinokandin dirençli ya da tedavi altında ekinokandin direnci gelişen vakalara ilişkin raporlar artmaktadır. Bu nedenle tüm Candida auris suşlarına antifungal duyarlılık testleri yapılmalı ve bireysel antifungal tedavi seçimine rehberlik etmek için kullanılmalıdır. Candida auris suşları antifungal ilaca maruz kaldıktan sonra hızla direnç geliştirebileceği için antifungal tedavi başlanan hastalar klinik iyileşme açısından dikkatle izlenmeli hastaların takip kültürleri ve tekrarlanan duyarlılık testleri yapılmalıdır. Panrezistan Candida auris izolatlarının ortaya çıkması tedavi seçeneklerini önemli ölçüde kısıtlamaktadır. Çoklu antifungal direnç varlığında kombinasyon tedavisi veya yeni antifungallerin kullanılması düşünülebilir. Direnç sorununun üstesinden gelebilecek yeni tedavi seçeneklerinin geliştirilmesi ve uygulamaya konulması Candida auris enfeksiyonlarının yönetilmesinde büyük bir öneme sahiptir. Bu amaçla Ibrexafungerp, Fosmanogepix, APX001A/APX001 ve rezafungin (CD101) gibi yeni ilaçların C. auris'e karşı aktivitesi üzerine araştırmalar yürütülmektedir.

Candida auris is a new type of Candida that can cause serious infections and is classified as multidrug-resistant (MDR) because it is resistant to many classes of antifungal drugs. While the majority of isolates were resistant to fluconazole, almost half were resistant to 2 or more antifungal drug classes. It shows consistently high minimum inhibitory concentrations against fluconazole and variable susceptibility to other triazoles, echinocandins, and amphotericin B. This high rate of resistance to existing commonly used antifungal drugs can lead to difficulties in treatment. Although echinocandins are recommended in first-line treatment, reports of echinocandin-resistant cases or cases developing echinocandin resistance under treatment are increasing. Therefore, antifungal susceptibility testing should be performed on all Candida auris strains and used to guide individual antifungal therapy. Since Candida auris can rapidly develop resistance after exposure to antifungal drugs, patients who are initiated on antifungal therapy should be carefully monitored for clinical improvement, and follow-up cultures and repeated antifungal susceptibility tests should be performed. The emergence of pan-resistant Candida auris isolates significantly limits treatment options. In the presence of multiple antifungal resistance, combination therapy or the use of new antifungals may be considered. Developing and implementing new treatment options that can overcome the resistance problem is very important in managing Candida auris infections. For this purpose, research is being conducted on the activity of new drugs such as Ibrexafungerp, Fosmanogepix, APX001A/APX001, and rezafungin (CD101) against C. auris.

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