THE MAIN MECHANISMS OF FUNGAL RESISTANCE TO ANTIFUNGAL AGENTS, A NARRATIVE REVIEW

Abstract

Fungal infections represent a growing public health problem, particularly among immunocompromised patients, hospitalized individuals, or those undergoing prolonged therapies. The extensive and, at times, inappropriate use of antifungal agents has significantly contributed to the emergence and dissemination of resistant fungal strains, compromising therapeutic efficacy and increasing morbidity and mortality rates. This narrative review aims to discuss, in an integrated and up-to-date manner, the main resistance mechanisms developed by fungi against different classes of antifungal agents, including azoles, polyenes, echinocandins, and antimetabolites. Molecular, biochemical, and cellular mechanisms involved in antifungal resistance are addressed, as well as their clinical implications and future perspectives for overcoming this emerging challenge.