Epidemiology and Control of Multidrug-Resistant Candida Infections

Multidrug-resistant Candida infections have emerged as a major public health challenge, driven by the rapid spread of Candida auris and the rising incidence of non-albicans species with resistance to multiple antifungal classes. Since its first identification in 2009, C. auris has shown the capacity for nosocomial transmission, prolonged surface survival and clonal expansion across continents. The epidemiology is characterised by distinct genetic clades exhibiting varied antifungal susceptibility profiles, facilitating regional outbreaks in intensive care and long-term care settings. Key drivers include inadequate diagnostic capacity leading to misidentification, suboptimal infection control and selective pressure from widespread azole use. Control strategies centre on rigorous surveillance, rapid molecular diagnostics, antifungal stewardship and enhanced environmental decontamination protocols. Novel approaches under investigation include next-generation sequencing for real-time outbreak tracking, targeted disinfection agents against biofilm reservoirs, and the development of new drug classes aiming to overcome established resistance mechanisms. A multidisciplinary response integrating epidemiology, clinical microbiology and infection prevention is essential to contain the spread of multidrug-resistant Candida and to mitigate its impact on vulnerable patient populations worldwide.

Research from Nature Portfolio

Recent studies have revealed that C. auris can rapidly evolve multicellular aggregative morphologies in the mammalian host, conferring enhanced resistance to host antimicrobial peptides. Genome analysis of evolving populations identified de novo mutations in genes governing cell wall integrity, cytokinesis and cytoskeletal organisation, underpinning adaptive morphological transitions during systemic infection. Complementary genomic investigations across all four major C. auris clades and related species have produced near-complete chromosome assemblies, uncovering conserved mating loci and expanded families of drug efflux transporters and lipases. Mutations and copy-number variations in the lanosterol demethylase gene have been mapped, providing insight into the genetic basis for azole resistance and highlighting potential targets for novel therapeutic interventions.

Epidemiology and Control of Multidrug-Resistant Candida Infections publication trend

The graph below shows the total number of articles in epidemiology and control of multidrug-resistant candida infections across all publications each year (not limited to Nature Index journals).

Technical terms

Multidrug-resistant: Organisms resistant to at least two classes of antifungal agents.

Biofilm: Structured microbial communities adherent to surfaces that confer enhanced resistance to drugs.

Efflux pump: Transport proteins that expel antifungal compounds from the cell, reducing drug efficacy.

Whole-genome sequencing: Comprehensive analysis of an organism’s complete DNA sequence for genetic characterisation.

Clade: A group of organisms sharing a common ancestor, identified by characteristic genetic markers.

Antifungal stewardship: Coordinated strategies to optimise antifungal use and limit resistance development.

References

1. Rapid evolution of an adaptive multicellular morphology of Candida auris during systemic infection. Nature Communications (2024).
2. Genomic insights into multidrug-resistance, mating and virulence in Candida auris and related emerging species. Nature Communications (2018).
3. Detection and characterisation of a sixth Candida auris clade in Singapore: a genomic and phenotypic study. The Lancet Microbe (2024).
4. Tracing the Evolutionary History and Global Expansion of Candida auris Using Population Genomic Analyses. mBio (2020).
5. Transcriptome Assembly and Profiling of Candida auris Reveals Novel Insights into Biofilm-Mediated Resistance. mSphere (2018).
6. Candida auris: Epidemiology, biology, antifungal resistance, and virulence. PLOS Pathogens (2020).