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Resistência aos antifúngicos e medidas de prevenção
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Atualmente, tanto em ambiente hospitalar como na comunidade, o aparecimento de infeções fúngicas de maior gravidade tem-se vindo a intensificar. Apesar dos claros avanços nas medidas de prevenção de infeções e nos métodos de diagnóstico e terapêutica, estas infeções continuam a causar um elevado índice de morbilidade e de mortalidade.
Com o consumo de antifúngicos a aumentar, tem-se verificado uma redução no seu espectro de atividade devido, na maioria dos casos, ao aparecimento de resistências por parte dos microrganismos. O surgimento de resistência ocorre através de diferentes tipos de mecanismos que o fungo adquire, contribuindo para a redução da eficácia do fármaco, quer por redução da sua concentração no local, quer por modificação do local de ação normal. A compreensão de todos os mecanismos de resistência existentes no fungo em questão, juntamente com o impacto clínico que advêm do aparecimento de resistência é essencial para o tratamento mais rápido, mais precoce e mais direcionado. Tal especificidade irá contribuir para o aumento da eficácia do tratamento.
As resistências mais conhecidas e estudadas pertencem à classe dos azóis, apresentando principalmente quatro tipos diferentes de resistências com a particularidade de, em todas, estar envolvida a componente de modificação genética. No que diz respeito às equinocandinas e polienos, os mecanismos de resistência ainda são pouco compreendidos.
Nowadays, both in hospital and in a community environment, the emergence of more serious fungal infections has been increasing. Despite recent advances in infection prevention measures and in diagnosis and therapy methods, these infections continue to cause a high rate of morbidity and mortality. With the increasing use of antifungal agents, there has been a reduction in their spectrum of activity due to, in most of the cases, the development of resistance by the microorganisms. The emergence of resistance occurs as different types of mechanisms which are acquired by the fungus, contributing to reduce drug efficacy, either by reducing its concentration in the local or changing the place of normal action. The understanding of every resistance mechanisms in the fungus, together with the clinical impact arising from the emergence of resistance is important for a faster, earlier and more targeted treatment. Such specificity will contribute to increase the efficacy of treatment. The most known and studied resistances belong to azoles class, showing mainly four different types of resistance with the particularity of, in all of them, the genetic modification component is involved. Regarding the echinocandins and polyenes, the resistance mechanisms are still poorly understood.
Nowadays, both in hospital and in a community environment, the emergence of more serious fungal infections has been increasing. Despite recent advances in infection prevention measures and in diagnosis and therapy methods, these infections continue to cause a high rate of morbidity and mortality. With the increasing use of antifungal agents, there has been a reduction in their spectrum of activity due to, in most of the cases, the development of resistance by the microorganisms. The emergence of resistance occurs as different types of mechanisms which are acquired by the fungus, contributing to reduce drug efficacy, either by reducing its concentration in the local or changing the place of normal action. The understanding of every resistance mechanisms in the fungus, together with the clinical impact arising from the emergence of resistance is important for a faster, earlier and more targeted treatment. Such specificity will contribute to increase the efficacy of treatment. The most known and studied resistances belong to azoles class, showing mainly four different types of resistance with the particularity of, in all of them, the genetic modification component is involved. Regarding the echinocandins and polyenes, the resistance mechanisms are still poorly understood.
Descrição
Trabalho Final de Mestrado Integrado, Ciências Farmacêuticas, Universidade de Lisboa, Faculdade de Farmácia, 2013
Palavras-chave
Micoses Epidemiologia Terapêutica Resistência Prevenção Mestrado Integrado - 2013