Candida Infections and Antifungal Resistance in Healthcare Settings
Summary
Candida species are leading causes of invasive fungal infections in hospitals, particularly among patients with indwelling medical devices, immunosuppression or prolonged antibiotic exposure. The most prevalent species—Candida albicans, Candida glabrata and Candida parapsilosis—readily adhere to central venous catheters and form biofilms that protect the fungus from host defences and antifungal agents. Recent surveillance has revealed rising rates of azole resistance, especially to fluconazole, and the emergence of multidrug-resistant and echinocandin-tolerant strains. Resistance often arises through mutations in the ERG11 gene or alterations in efflux pump regulation, enabling survival under therapeutic pressure. Clonal outbreaks of resistant isolates have been documented across continents, underscoring the role of environmental reservoirs, healthcare worker hand carriage and lapses in disinfection protocols. The global spread of resistant Candida threatens to erode current treatment options and poses significant morbidity, mortality and economic burdens. A holistic response—encompassing antifungal stewardship, rapid diagnostics, stringent infection control and novel therapeutic development—is critical to curb the proliferation of resistant Candida in clinical environments.
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Candida Infections and Antifungal Resistance in Healthcare Settings publication trend
The graph below shows the total number of articles in candida infections and antifungal resistance in healthcare settings across all publications each year (not limited to Nature Index journals).
Technical terms
Biofilm: A structured community of fungal cells embedded in an extracellular matrix that adheres to surfaces and confers protection against antifungals and immune responses.
Azoles: A class of antifungal agents that inhibit ergosterol synthesis by targeting the fungal lanosterol 14α-demethylase enzyme.
Echinocandins: Antifungal drugs that disrupt fungal cell wall integrity by inhibiting β-(1,3)-glucan synthase.
Clonal outbreak: The propagation of genetically identical fungal strains across multiple patients or environments within a healthcare setting.
Resistance mechanisms: Genetic mutations or regulatory changes in Candida that reduce susceptibility to antifungal agents, such as ERG11 alterations or efflux pump overexpression.
References
- Worldwide emergence of fluconazole-resistant Candida parapsilosis: current framework and future research roadmap. The Lancet Microbe (2023).
- Evaluation of outbreak persistence caused by multidrug-resistant and echinocandin-resistant Candida parapsilosis using multidimensional experimental and epidemiological approaches. Emerging Microbes & Infections (2024).
- European candidaemia is characterised by notable differential epidemiology and susceptibility pattern: Results from the ECMM Candida III study. Journal of Infection (2023).
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