Introduction (Article introduction authored by ICU Editorial Team) Invasive candidiasis presents an escalating global health threat, characterized by increasing incidence and high mortality rates despite limited therapeutic choices. The rapid spread of antifungal resistance, especially among multidrug-resistant species, exacerbates this challenge. Effective antifungal stewardship and rigorous infection control practices are essential, yet the impact of antifungal monotherapy on fostering resistance necessitates careful evaluation.
Combination therapy holds promise in mitigating resistance development, enhancing drug penetration, accelerating fungal clearance, and minimizing toxicity. Laboratory studies indicate synergistic effects against Candida spp., including the challenging multidrug-resistant Candida auris. Clinical trials are imperative to confirm these synergies and assess resistance outcomes.
Candida bloodstream infections affect approximately 750,000 individuals annually, with mortality rates ranging from 10% to 47%. Treatment options are limited, and resistance to existing therapies is on the rise. While new antifungal agents are emerging, their environmental use and single-agent clinical applications pose risks of accelerating resistance. Advancements in pharmaceutical strategies are critical to safeguard the efficacy of current and future antifungal treatments. The scope of the problem – Antifungal-Resistant Candida spp The extensive use of antifungal medications has triggered a global epidemiological shift towards Candida spp. with reduced susceptibility to azoles, leading to increasing secondary resistance and the emergence of multi-drug resistant strains such as C. auris and C. glabrata (Nakaseomyces glabrata). Non-albicans species, notably C. krusei and C. glabrata, are gaining prevalence worldwide and now constitute more than half of invasive cases in SENTRY surveillance.
Azole-resistant C. parapsilosis has emerged as a global concern, with growing fluconazole resistance documented worldwide. C. auris is particularly alarming due to its widespread resistance to azoles and its emerging resistance to other classes of antifungals.
Although echinocandin resistance remains uncommon, its incidence is rising, posing a threat to this crucial class of drugs. Global outbreaks of C. auris persist, with the fungus becoming a predominant pathogen in certain regions. As azole resistance increases, there is a heightened reliance on echinocandins, jeopardizing their effectiveness as well.