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. 2020 Jan 22;8(2):154.
doi: 10.3390/microorganisms8020154.

Candida albicans Antifungal Resistance and Tolerance in Bloodstream Infections: The Triad Yeast-Host-Antifungal

Free PMC article

Candida albicans Antifungal Resistance and Tolerance in Bloodstream Infections: The Triad Yeast-Host-Antifungal

Sofia Costa-de-Oliveira et al. Microorganisms. .
Free PMC article


Candida albicans represents the most frequent isolated yeast from bloodstream infections. Despite the remarkable progress in diagnostic and therapeutic approaches, these infections continue to be a critical challenge in intensive care units worldwide. The economic cost of bloodstream fungal infections and its associated mortality, especially in debilitated patients, remains unacceptably high. Candida albicans is a highly adaptable microorganism, being able to develop resistance following prolonged exposure to antifungals. Formation of biofilms, which diminish the accessibility of the antifungal, selection of spontaneous mutations that increase expression or decreased susceptibility of the target, altered chromosome abnormalities, overexpression of multidrug efflux pumps and the ability to escape host immune defenses are some of the factors that can contribute to antifungal tolerance and resistance. The knowledge of the antifungal resistance mechanisms can allow the design of alternative therapeutically options in order to modulate or revert the resistance. We have focused this review on the main factors that are involved in antifungal resistance and tolerance in patients with C. albicans bloodstream infections.

Keywords: C. albicans; Candida infections; antifungal resistance; bloodstream infections; virulence.

Conflict of interest statement

The authors declare no conflict of interests.


Figure 1
Figure 1
Risk factors that contribute to clinical resistance. Information was collected from the following references: [5,13,47,54,76,95,100,103,122,126,141,142,143,144,145,146].

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    1. Calderone R., editor. Candida and Candidiasis. ASM Press; Washington, DC, USA: 2002.
    1. Cannon R.D., Holmes A.R., Mason A.B., Monk B.C. Oral Candida: Clearance, colonization, or candidiasis? J. Dent. Res. 1995;74:1152–1161. doi: 10.1177/00220345950740050301. - DOI - PubMed
    1. Casadevall A., Pirofski L.A. Accidental virulence, cryptic pathogenesis, martians, lost hosts, and the pathogenicity of environmental microbes. Eukaryot. Cell. 2007;6:2169–2174. doi: 10.1128/EC.00308-07. - DOI - PMC - PubMed
    1. Segal B.H., Almyroudis N.G., Battiwalla M., Herbrecht R., Perfect J.R., Walsh T.J., Wingard J.R. Prevention and early treatment of invasive fungal infection in patients with cancer and neutropenia and in stem cell transplant recipients in the era of newer broad-spectrum antifungal agents and diagnostic adjuncts. Clin. Infect. Dis. Off. Publ. Infect. Dis. Soc. Am. 2007;44:402–409. doi: 10.1086/510677. - DOI - PubMed
    1. Pfaller M.A., Diekema D.J. Epidemiology of invasive candidiasis: A persistent public health problem. Clin. Microbiol. Rev. 2007;20:133–163. doi: 10.1128/CMR.00029-06. - DOI - PMC - PubMed