Refractory fungal infection: Three case reports highlighting good practice

Abstract

Refractory invasive fungal disease is a significant clinical problem, with high morbidity, mortality and costs. The complex causes of refractory infection include breakthrough infection due to antifungal resistance (both innate and acquired), suboptimal therapy and impaired immune responses in critically ill or immunocompromised patients. This case series details three reports on the identification and management of refractory fungal infections, two cases of azole resistance and one case of resistant candidiasis, highlighting the importance of accurate diagnosis, monitoring, implementation of biomarkers (serological markers, PCR), antifungal susceptibility testing and antifungal stewardship to optimise management and minimise risks of emergence of drug resistance.

Keywords

• Refractory fungal infection
• Breakthrough fungal infection
• Invasive fungal disease
• Antifungal resistance
• Antifungal susceptibility testing
• Fungal biomarkers