Antifungal tolerance and resistance dynamics depend on infection load, drug treatment, and host innate immunity

Fungi contribute substantially to the global antimicrobial resistance crisis. Tolerance is a novel form of antifungal resistance in which fungal pathogens emerge, grow slowly, and survive antifungal drug treatment. We quantitatively model the population and evolutionary dynamics of a multidrug resistant pathogen Candidozyma auris (formerly Candida auris) infecting an invertebrate host (Galleria mellonella) with an innate immune system. We find that the establishment, dominance, and co-existence of tolerant and resistant subpopulations depend on infection load, drug treatment, and innate host immunity. This study enhances our understanding of the population and evolutionary dynamics of pathogenic infections and provides a quantitative framework to predict antimicrobial resistance.

Galon, C. M., Charlebois, D. A.

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