ArticleNature medicine2024
Antifungal heteroresistance causes prophylaxis failure and facilitates breakthrough Candida parapsilosis infections.
Article in Nature medicine, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
37 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Global trends and research profile of antibiotic heteroresistance: a bibliometric and visual analysis.Frontiers in microbiology · 2026Pooled it
- Beyond antifungal susceptibility: molecular mechanisms, detection, and clinical implications of fungal heteroresistance.Molecular biology reports · 2026Review
- Intracellular acidification by microbiota-derived valeric acid facilitates trans-kingdom ecology limiting Candida parapsilosis colonization.Cell host & microbe · 2026Article
- Innovation in antifungal therapy.EMBO molecular medicine · 2026Review
- Blood Cultures Contain Populations of Genetically Diverse Candida albicans Strains that May Differ in Echinocandin Tolerance and Fitness.The Journal of infectious diseases · 2026Article
- Genomic Characterization of Candida spp. Highlights a Persistent, Azole-Resistant C. parapsilosis Clone Circulating in a Tertiary Care Hospital During the First COVID-19 Wave.Mycopathologia · 2026Article
- Persistence and spread of fluconazole-resistantMicrobial genomics · 2026Article
- Echinocandin tolerance and persistencemBio · 2026Article
- Review
- Emerging antifungal resistance in Candida parapsilosis: the end of the innocence.npj antimicrobials and resistance · 2025Review
- Antifungal treatment strategies and their impact on resistance development in clinical settings.The Journal of antimicrobial chemotherapy · 2025Review
- Study on the heteroresistance of carbapenem-resistant Klebsiella pneumoniae to Tigecycline and Polymyxin B and antibacterial activity of combined drugs in vitro.BMC microbiology · 2025Article
- Stress-driven emergence of heritable non-genetic drug resistance.Research square · 2025Article
- Mucosal-Associated Invariant T Cells: Origins, Biological Functions, Diseases, and Therapeutic Targets.MedComm · 2025Review
- Review
- Antifungal persistence: Clinical relevance and mechanisms.PLoS pathogens · 2025Review
- Clinical impact of fluconazole-resistantFuture microbiology · 2025Review
- Ecological management of the microbiota in patients with cancer.Nature reviews. Clinical oncology · 2025Review
- Article
- Investigation of voriconazole heteroresistance in clinical isolates ofMicrobiology spectrum · 2025Article
Corrections and comments
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Authors and funding
18 authors.
Funding
Abstract
Breakthrough fungal infections in patients on antimicrobial prophylaxis during allogeneic hematopoietic cell transplantation (allo-HCT) represent a major and often unexplained cause of morbidity and mortality. Candida parapsilosis is a common cause of invasive candidiasis and has been classified as a high-priority fungal pathogen by the World Health Organization. In high-risk allo-HCT recipients on micafungin prophylaxis, we show that heteroresistance (the presence of a phenotypically unstable, low-frequency subpopulation of resistant cells (~1 in 10,000)) underlies breakthrough bloodstream infections by C. parapsilosis. By analyzing 219 clinical isolates from North America, Europe and Asia, we demonstrate widespread micafungin heteroresistance in C. parapsilosis. Standard antimicrobial susceptibility tests, such as broth microdilution or gradient diffusion assays, which guide drug selection for invasive infections, fail to detect micafungin heteroresistance in C. parapsilosis. To facilitate rapid detection of micafungin heteroresistance in C. parapsilosis, we constructed a predictive machine learning framework that classifies isolates as heteroresistant or susceptible using a maximum of ten genomic features. These results connect heteroresistance to unexplained antifungal prophylaxis failure in allo-HCT recipients and demonstrate a proof-of-principle diagnostic approach with the potential to guide clinical decisions and improve patient care.
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Identifiers
What Socratic holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.