Antifungal Resistance Research Articles

Giant transposons promote strain heterogeneity in a major fungal pathogen.

Fungal infections are difficult to prevent and treat in large part due to strain heterogeneity, which confounds diagnostic predictability. Yet, the genetic mechanisms driving strain-to-strain variation remain poorly understood. Here, we determined the extent to which Starships-giant transposons capable of mobilizing numerous fungal genes-generate genetic and phenotypic variability in the opportunistic human pathogen Aspergillus fumigatus. We analyzed 519 diverse strains, including 11 newly sequenced with long-read technology and multiple isolates of the same reference strain, to reveal 20 distinct Starships that are generating genomic heterogeneity over timescales relevant for experimental reproducibility. Starship-mobilized genes encode diverse functions, including known biofilm-related virulence factors and biosynthetic gene clusters, and many are differentially expressed during infection and antifungal exposure in a strain-specific manner. These findings support a new model of fungal evolution wherein Starships help generate variation in genome structure, gene content, and expression among fungal strains. Together, our results demonstrate that Starships are a previously hidden mechanism generating genotypic and, in turn, phenotypic heterogeneity in a major human fungal pathogen.IMPORTANCENo "one size fits all" option exists for treating fungal infections in large part due to genetic and phenotypic variability among strains. Accounting for strain heterogeneity is thus fundamental for developing efficacious treatments and strategies for safeguarding human health. Here, we report significant progress toward achieving this goal by uncovering a previously hidden mechanism generating heterogeneity in the human fungal pathogen Aspergillus fumigatus: giant transposons, called Starships, that span dozens of kilobases and mobilize fungal genes as cargo. By conducting a systematic investigation of these unusual transposons in a single fungal species, we demonstrate their contributions to population-level variation at the genome, pangenome, and transcriptome levels. The Starship compendium we develop will not only help predict variation introduced by these elements in laboratory experiments but will serve as a foundational resource for determining how Starships impact clinically relevant phenotypes, such as antifungal resistance and pathogenicity.

Research progress on the drug resistance mechanisms of Candida tropicalis and future solutions

Candida tropicalis is an important member of the non-Candida albicans species. It is closely associated with candidemia, especially common in neutropenic and critically ill patients. Drug-resistant C. tropicalis isolates have been found not only in clinical patients but also in animals, fruits, and the environment. In recent years, the detection rate of azole-resistant C. tropicalis isolates has increased. Drug-resistant C. tropicalis is related to persistent, recurrent, and breakthrough infections. Therefore, understanding its drug resistance is crucial for clinical treatment. The review explores the main mechanisms of C. tropicalis resistance to antifungal drugs and discusses the genetic basis involved in the antifungal resistance of C. tropicalis. In addition, current research on natural extracts, nanomaterials, etc. used for antifungal purposes has also been reviewed. The aim of this review is that in-depth research on the drug resistance mechanisms of C. tropicalis resistant strains can help guide clinical medication. Meanwhile, it can also provide new ideas for opening up new pathways, searching for new targets, and screening out safe and effective “antifungal candidates,” with the expectation of improving the current clinical cure rates.

Peptide‐Decorated Liposomes Enhance Fungal Targeting and Antifungal Drug Delivery

AbstractCandida infections are a clinical challenge due to a limited repertoire of antifungal drugs, biofilm development, and antifungal drug resistance. Fungi‐targeted liposomes can improve antifungal drug solubility and delivery while reducing toxicity by enhancing fungal cell interaction. Here, liposomes that encapsulate the antifungal drug, posaconazole (POS), are decorated with the peptide, penetratin (Pen). Liposome‐fungal cell interaction increases significantly from ∼50% to >80% upon Pen conjugation with both C. albicans and C. auris. Pen‐decorated liposomes containing POS inhibit planktonic C. albicans and C. auris at liposome concentrations up to 8× lower than non‐Pen‐decorated liposomes, suggesting enhanced POS delivery due to increased fungal targeting. Furthermore, Pen‐decorated liposomes inhibit C. albicans and C. auris biofilm formation at POS concentrations that are up to 1300× lower than free POS. Finally, Pen‐decorated liposomes exhibit promising prophylactic activity in an intradermal C. albicans murine infection model, reducing fungal burden by ∼60% compared to non‐targeting POS‐loaded liposomes. Overall, Pen‐decorated, POS‐loaded liposomes expand the antifungal drug repertoire against Candida spp. and serve as a platform technology to improve the treatment of fungal infections.

Antifungal Resistance in Vaginal Candidiasis Among Reproductive-age Women: A Review.

Candida is a type of fungus that can cause infections in humans. Sometimes, these infections become tough to treat because the Candida fungus resists antifungal drugs. This resistance depends on both the specific type of Candida and how it interacts with the human body. For instance, Candida can change its genetic makeup or produce proteins that pump out the drugs, making them less effective. Additionally, Candida can form a protective layer called a biofilm, which shields it from the drugs. Candida can cause a variety of diseases, and vaginal candidiasis is among the most troublesome. Nearly every woman experiences this infection at least once in her lifetime. Higher rates of treatment failures and recurrent infections result from the developing issue of antifungal resistance, underscoring the need for a more thorough understanding of resistance mechanisms. Changes in hormonal levels and immune responses can significantly influence the effectiveness of antifungal treatments. Hormonal fluctuations can alter vaginal pH and immune functions, which in turn affects Candida colonization and persistence. Moreover, an imbalance in the vaginal microbiome can lead to an overgrowth of Candida and lead to the drug resistance candidiasis. This review delves into the molecular pathways that contribute to the resistance of vaginal candidiasis to antifungal treatments, focusing on both acquired and intrinsic resistance mechanisms. Acquired resistance develops due to genetic alterations following antifungal exposure, including mutations in genes encoding drug targets, overexpression of efflux pumps, and increased biofilm formation. In contrast, intrinsic resistance refers to the innate traits of the Candida species that inherently reduce the efficacy of antifungal agents. These characteristics include changes in membrane sterols, genetic mutations in target enzymes, and the presence of efflux pumps that remove antifungal medications. Understanding these complex mechanisms can inform future therapeutic strategies and improve clinical outcomes.

A Range of Biological Medications Utilized for The Treatment of Fungal Infections

A worldwide health concern, fungal infections impact more than one billion people annually, and their occurrence is steadily rising due to environmental changes, an increase in impaired populations, and antifungal resistance. Because of their high rates of resistance and death, fungi such as Aspergillus fumigatus, albicans Candida, Candida auris, & Cryptococcus neoformans, for example, have been designated as important priority by the WHO. The four medication classes used in current antifungal therapies—polyenes, azoles, echinocandins, and flucytosine—are hampered by toxicity as well as resistance, and their molecular targets are restricted since the eukaryotic state of the fungal infections is so like that of the host. The creation of vaccinations that target certain common antigens, such as β-1,3-glucan, immunotherapeutics, which includes the utilization of monoclonal antibodies, like mAb 2G8 as well as efungumab, and novel drug discoveries are some of the potential strategies. By identifying factors affecting virulence and metabolic pathways as potential targets for intervention, omics techniques (genomics, proteomics, and metabolomics) are revolutionizing fungal research. However, host diversity and fungal immune evasion further complicate the vaccine development process. Potential creation of antifungal chemicals from medicinal plants and marine species is also being investigated. Multidisciplinary action is required to develop safe and efficient treatments for high-risk groups, support diagnostics, and launch an attack against resistance mechanisms.

Candida auris is emerging as a prevalent urinary pathogen.

Urinary tract infections (UTIs) are one of the most common infections, with a subgroup of these infections, catheter-associated UTIs (CAUTIs), accounting for 40% of nosocomial infections. While the majority of CAUTI pathogens are bacterial, the second most common pathogen is the fungus Candida albicans. However, in recent years, Candida auris has increasingly been isolated from urine, indicating C. auris' potential as a urinary pathogen. C. auris has rapidly emerged as a human pathogen worldwide, becoming a serious health threat. This is of great concern due to its antifungal resistance, adherence to inanimate surfaces, high mortality rates, and the extensive knowledge gap regarding C. auris' prevalence and pathophysiology. To understand whether C. auris is prevalent in the urinary tract, we analyzed 12,996 C. auris clinical strains and their frequency related to urine and urinary catheters. We identified urine as the second most common C. auris isolation source in the United States and the third most common worldwide. Anecdotally, C. auris urine isolates are often associated with urinary catheters and high mortality rates. Furthermore, there has been an early indication of urinary isolates developing echinocandin resistance. With the increasing incidence of uropathogenic C. auris, it is critical to have an in-depth understanding of C. auris pathogenesis in the urinary tract to effectively prevent and treat these infections.

Chitosan-Based Intelligent Microneedles for Delivery of Amphotericin B Loaded Oleosomes: Antifungal Ocular Patch Targeting for Effective Against Fungal Keratitis Using Rabbit Model via TLR4/NLRP3 Pathway.

Fungal keratitis (FK), a major cause of blindness, remains challenging to treat due to poor drug penetration and antifungal resistance. Amphotericin-B (AmB), a water-insoluble and low-permeability, necessitates innovative delivery systems to improve its therapeutic efficacy. AmB was encapsulated within oleosomes (Ole) prepared using the ethanol injection method, using phosphatidylcholine (Lipoid S100) and sodium oleate, resulting in nanosized spherical globules. The optimized Ole were characterized, then the selected Ole were incorporated into sodium polyacrylate/PEG/chitosan-based microneedles (AmB-Ole/MNs) to improve ocular delivery by creating transient microchannels on the eye surface. The optimized Ole showed a droplet size of (175 ± 0.78 nm), polydispersity index of (0.33 ± 0.04), zeta potential of (31 ± 0.43 mV), high entrapment efficiency (91±0.63%), and improved stability, bioavailability, and controlled drug release. The AmB-Ole/MNs system increases corneal penetration and contact time via transient microchannels in the eye surface, achieving sustained drug delivery over 72 hours with 70% ex vivo permeation over 80 hours compared to AmB. In vitro antifungal activity and histopathological examination showed that the AmB-Ole/MNs system has potent biofilm disruption (>90%) and 27 mm and 32 mm zones of inhibition against Candida albicans and Aspergillus niger, respectively. The Cytotoxicity test showed reduced AmB toxicity with biocompatibility and in vivo rabbit model, ocular tolerance by targeting TLR4/NLRP3 pathways and histopathological studies. The AmB-Ole/MNs system as an innovative ocular delivery platform for fungal keratitis offers sustained drug release, enhanced permeation, potent antifungal activity, and reduced toxicity. AmB-Ole/MNs showed promise for ocular AmB delivery for FK.

Candida infections in COVID-19 patients: A review of prevalence, risk factors, and mortality.

Candida infections in COVID-19 patients: A review of prevalence, risk factors, and mortality.

A novel lncRNA YIL163C enhances genomic stability and antifungal resistance via the DNA damage response in Saccharomyces cerevisiae

IntroductionLong non-coding RNAs (lncRNAs) are increasingly recognized as key regulators in cellular processes, including the DNA damage response (DDR). In Saccharomyces cerevisiae, DDR is critical for maintaining genomic integrity under stress, mediated by proteins like Mec1 and Rad53. However, the involvement of lncRNAs in DDR pathways, remains largely unexplored. This study investigates the function of a novel lncRNA, YIL163C, in promoting cell survival and genomic stability under DNA damage conditions.MethodsGenetic suppressor screening was employed to assess the role of YIL163C in rescuing lethality in mec1Δ sml1Δ and rad53Δ sml1Δ exposed to DNA damage. Proteomic and phosphoproteomic analyses were conducted to evaluate changes in protein abundance and phosphorylation states. The impact of YIL163C on DDR and antifungal drug tolerance, specifically to 5-fluorocytosine, was also examined.ResultsOverexpression of YIL163C was found to rescue lethality in mec1Δ sml1Δ and rad53Δ sml1Δ under DNA damage conditions. Proteomic analyses revealed that YIL163C modulates pathways related to DNA replication, ER stress response, and ribosome biogenesis, enhancing cellular resilience to HU-induced stress. Additionally, YIL163C reduced sensitivity to 5-fluorocytosine, indicating a role in antifungal drug tolerance. Phosphoproteomic data suggested YIL163C influences phosphorylation states, potentially acting downstream of the Mec1-Rad53 signaling pathway.ConclusionThis study provides new insights into the regulatory mechanisms of lncRNAs in DDR, with broader implications for antifungal therapy and genomic stability research, emphasizing the role of lncRNAs in stress responses beyond traditional protein-centric mechanisms.

Novel Disk diffusion Assay for Filamentous Fungi Susceptibility to antifungals (DAFFS).

Novel Disk diffusion Assay for Filamentous Fungi Susceptibility to antifungals (DAFFS).

First report of increased amphotericin B resistance in Coniochaeta polymorpha isolates from Rangifer tarandus platyrhynchus droppings in Spitsbergen.

First report of increased amphotericin B resistance in Coniochaeta polymorpha isolates from Rangifer tarandus platyrhynchus droppings in Spitsbergen.

Common Disease—Difficult Understanding: Readability Analysis of Superficial Skin Fungal Infections On‐Line Materials in European Languages

ABSTRACTBackgroundStudies analysing the readability of online materials about dermatomycoses were very limited.ObjectivesThis study evaluated the readability of online materials related to superficial skin fungal infections in English, German, French, Italian, Spanish and Polish.MethodsThe terms ‘dermatomycosis’, ‘dermatophytosis’ and ‘trichophytosis’ translated into included languages were searched using the Google search engine. The first 50 records in each language were screened for suitability. Articles that were accessible, relevant to dermatological fungal infections and aimed at patient education were included. The LIX score was utilised to assess readability.ResultsIn general, 167 articles out of 900 screened (19%) were analysed. The overall mean LIX score was 56 ± 7, which classified articles as very difficult to comprehend. The most readable were articles retrieved with the search term ‘trichophytosis’ with a mean LIX score of 49 ± 3, followed by ‘dermatophytosis’ with 54 ± 8 and ‘dermatomycosis’ with 58 ± 7 (p < 0.001). The most readable articles were in English (48 ± 7) and Spanish (50 ± 5), followed by German (54 ± 4), French (55 ± 6), Italian (59 ± 5) and Polish (63 ± 4) (p < 0.001). The increase in the number of analysed articles was correlated with a higher average LIX score (p = 0.036, R2 = 0.708).ConclusionsLow availability and readability of online patient materials related to superficial skin fungal infections could hinder patient understanding, leading to improper antifungal use, increased recurrence rates and the risk of antifungal resistance. The dermatologists should take action to ensure adequate online materials in Internet‐based society.

Synergistic Antifungal Efficacy of Eugenol-Loaded Nanocapsules Combined With Itraconazole Against Trichophyton mentagrophytes.

The increasing prevalence of dermatophyte infections and the emergence of antifungal resistance highlight the urgent need for novel treatment approaches. Trichophyton mentagrophytes, a common dermatophyte, often resists standard antifungal therapies, necessitating alternative solutions. Eugenol, a natural compound with potent antifungal properties, has gained attention for its synergistic effects with conventional antifungal agents. However, its clinical application is limited by poor bioavailability and stability. Nanoencapsulation of eugenol offers a promising strategy to enhance its antifungal efficacy and address these limitations. This study aims to evaluate the antifungal efficacy of eugenol and nanoencapsulated eugenol in combination with Itraconazole against T. mentagrophytes isolates. Eugenol-loaded nanocapsules were fabricated using the nanoprecipitation method and subsequently evaluated. The antifungal activity of eugenol, nano-eugenol and Itraconazole-individually and in combination-was assessed against clinical isolates of T. mentagrophytes derived from animal and human sources, using minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) determinations. The chequerboard assay evaluated the synergistic effects. Scanning electron microscopy (SEM) and dynamic light scattering (DLS) analyses showed that eugenol nanocapsules have a uniform, spherical morphology with an average size of 150.9nm and moderate polydispersity (polydispersity index [PDI]=0.531), whereas a slight negative zeta potential (-0.1mV) contributes to suspension stability by minimizing aggregation. The geometric mean MIC of eugenol was 119.3µg/mL, significantly lower than that of nano-eugenol (477.4µg/mL), whereas Itraconazole had the lowest MIC at 11µg/mL. Eugenol demonstrated a more potent fungicidal effect than its nanoencapsulated form, though nanoencapsulation improved stability and bioavailability. Combining Itraconazole with nano-eugenol showed synergy in 73.3% of T. mentagrophytes isolates, reducing Itraconazole's MIC by up to 1/2 or 1/4. Both forms of eugenol exhibited effective anti-dermatophytic activity. The findings suggest that nanoencapsulated eugenol, in combination with Itraconazole, provides a potent and synergistic antifungal approach against T. mentagrophytes, potentially reducing the dosage and resistance risks associated with Itraconazole. These results underscore the potential of nano-enhanced plant extracts in developing effective, sustainable antifungal therapies.

Identification of yeast in healthy and subclinical mastitis-diagnosed Anatolian buffaloes insmallholder dairy farms in Turkey.

This study aimed to identify yeast species in healthy Anatolian buffaloes and those with subclinical mastitis on smallholder farms using the Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS) method and assess antifungal resistance. Milk samples from 390udder lobes of 100 buffaloes were tested and California Mastitis Test (CMT) results showed 265negative, 102 suspicious and 23 CMT ≥+1 lobes. A total of 76 yeast isolates (19.5%) were obtained through classical culture methods. MALDI-TOF MS identified seven genera, with the most common species being Pichia kudriavzevii (54%), Kluyveromyces marxianus (21%) and Nakaseomyces glabrata (10.5%). Antifungal resistance was determined by the disk diffusion method, showing the highest resistance to caspofungin (69.7%), followed by fluconazole (65.8%) and ketoconazole (31.6%). Thisstudy highlights the presence of diverse yeast species in buffalo milk, emphasizing the importance of understanding their role in mastitis and antifungal resistance for animal and public health. To our knowledge, this is the first study showing the identification of different yeast species isolated from Anatolian buffaloes in smallholder dairy farms in Turkey.

The Influence of the Seasonal Variability of Candida spp. Bloodstream Infections and Antifungal Treatment: A Mediterranean Pilot Study

Background/Objectives: Various factors associated with seasonality, including temperature, humidity, geographical composition, and seasonal fluctuations, can influence the trends of microbes responsible for hospital infections, such as Candida spp. This study evaluates the seasonal variability of Candida spp. bloodstream infections and antifungal resistance in hospitalized patients in Sicily. Methods: We retrospectively analyzed the demographic and epidemiological characteristics of 175 patients with blood cultures positive for Candida spp. Who were hospitalized at University Hospital Paolo Giaccone (A.U.O.P.), University of Palermo, Italy, from 1 January 2022 to 31 December 2024. Data on Candida species and antifungal resistance were also collected from the hospital’s database system to prevent and control hospital infections in A.U.O.P. Results: A total of 175 patients, 57.7% males, with a mean age of 68.3 years, were included in this study. Candida parapsilosis, Candida albicans, and Candida glabrata were more frequent in ICU (54.5%, p = 0.0001), medical (72.5%, p = 0.0003), and surgical settings (24%, p = 0.0161), respectively. C. parapsilosis was more frequent in dead patients (53.2%, p = 0.005). Among the seasons, we observed a significantly higher presence of C. glabrata in Autumn (20%, p = 0.0436). From the analysis of the seasons, C. parapsilosis and C. albicans were more frequent for each season, except in Spring, where the most frequent isolates were C. glabrata (5.1%, p = 0.0237) and C. parapsilosis (9.7%, p < 0.0001). The antifungal with the most resistance to Candida spp. was fluconazole in all seasons. Conclusions: Our study highlights the seasonal trends in Candida spp. and antifungal resistance, emphasizing climate change’s challenges on fungal diseases. These findings may contribute to improving prevention and treatment strategies for candidemia.

The S862C amino acid change in CpMrr1 confers fluconazole resistance in Candida parapsilosis.

Candida parapsilosis is an opportunistic pathogen with increasing rates of resistance to fluconazole and voriconazole. Recently, in an outbreak at the Azienda Ospedaliero-Universitaria Pisana, a new amino acid substitution, S862C in the CpMrr1 protein, was found only in azole-resistant strains. The contribution of this mutation to the acquisition of an azole-resistant phenotype was investigated in this study. Antifungal resistance in C. parapsilosis clinical strains isolated from the outbreak (n = 16) was tested by the broth microdilution method and Etest strip. WGS and Sanger sequencing analyses were used for the detection of SNPs. A CRISPR-Cas9-based genome editing strategy was used to induce the C2585G substitution in the CpMRR1 gene of susceptible C. parapsilosis isolates to investigate its role in the acquisition of azole resistance. The A395T and the newly found C2585G substitution in the CpMRR1 gene were present in all resistant isolates, but not in the susceptible ones. Such mutations were later induced in the C. parapsilosis reference strain ATCC 22019 and in two azole-susceptible clinical isolates in homozygosis, and in heterozygosis only for ATCC 22019 and one azole-susceptible clinical isolate. Both heterozygous and homozygous mutants carrying the C2585G mutation were fluconazole resistant, with some clones also presenting intermediate susceptibility or resistance to voriconazole. To the best of our knowledge, this is the first study to report the effect on azole resistance of a novel C2585G nucleotide substitution in the CpMRR1 gene found in clinical isolates recovered during an outbreak of azole-resistant C. parapsilosis in a healthcare setting.

Patients knowledge attitudes and practices regarding superficial fungal infections suggest public health and patient education are warranted

Superficial fungal infections are common worldwide and significantly impact public health. Understanding patients’ knowledge, attitudes, and practices (KAP) regarding their treatment and prognosis is essential for addressing gaps in care. This cross-sectional study utilized a self-designed KAP questionnaire to assess 456 patients with superficial fungal infections between October 15, 2023, and March 15, 2024. Data analysis included descriptive statistics, logistic regression, and structural equation modeling. The mean scores for knowledge, attitudes, and practices were 14.85 ± 7.75, 27.01 ± 4.28, and 22.91 ± 4.17, respectively. Key findings revealed that 32% of patients were unsure about long-term treatment, 51% misunderstood corticosteroid use, and 69% believed medications could be stopped once symptoms improved. Significant demographic disparities in KAP scores were observed, highlighting the influence of gender, age, education, and income. Patients exhibit inadequate knowledge, predominantly negative attitudes, and suboptimal practices regarding superficial fungal infections. Targeted educational interventions are crucial for enhancing treatment adherence, addressing misconceptions, and reducing antifungal resistance.

Genomic epidemiology and antifungal resistance of emerging Trichophyton indotineae in China

ABSTRACT The emergence and spread of antifungal-resistant Trichophyton indotineae pose an increasing public health concern worldwide. Multidrug-resistant T. indotineae infections have been reported in China in the past few years. To understand the genetic relationship and the origin of these Chinese isolates, as well as their relationship to the global collections, we sequenced the whole genomes of 31 isolates using the Illumina platforms. Genomic epidemiology was performed on a dataset of 181 T. indotineae isolates from China and 8 other countries, representing the largest genome-wide analysis. Single nucleotide polymorphism analysis revealed that T. indotineae can be divided into four distinct phylogenetic groups (I, II, III, IV), with regional clonal transmission clusters identified in eastern China; T. indotineae was introduced into China more than once given the genetic variability. The isolates from South Asia may be the source of Chinese isolates based on epidemiological information. There were differences in the prevalence and resistance profiles among four phylogenetic groups, with Group III being predominant and exhibiting a higher terbinafine resistance rate of 88.24% and azole resistance. Also, we characterized the role of gene mutation, copy number variation, and gene expression in antifungal drug resistance. Terbinafine resistance could be mainly associated with Phe397Leu substitution in SQLE, and azole resistance might be related to increased copy number of CYP51B, as well as elevated MDR2 and MDR3 expression. Given the clinical challenges posed by T. indotineae, this emerging dermatophyte should be recognized as a global threat, necessitating urgent collaborative surveillance and management strategies.

Maintain a high index of suspicion for antifungal resistance when treating skin and hair dermatophytoses

Maintain a high index of suspicion for antifungal resistance when treating skin and hair dermatophytoses

Prevalence of fungi and their antifungal and disinfectant resistance in hospital environments: insights into combating nosocomial mycoses

BackgroundFungal infections are increasingly recognized as a global health concern, contributing to considerable morbidity and mortality in hospital settings. This underscores the urgent need for infection prevention and control in healthcare facilities to protect vulnerable patients from the risk of acquiring invasive fungal diseases (IFDs). Given the critical role of transmission-based precautions in limiting the spread of filamentous fungi responsible for IFDs, this study was conducted to explore the potential role of the hospital environment in the dissemination of these infections.MethodsA total of 83 samples were collected from the air and surface of exhaust vents in the intensive care units (ICUs) of hospitals in Isfahan, Iran, to assess the presence and diversity of fungal species. Susceptibility testing against antifungal agents, including commonly used drugs and disinfectants, was performed on the identified fungal isolates. Furthermore, the antifungal resistance profiles of isolates from clinical IFD cases were compared with those of environmental isolates.ResultsFungi were detected in 45% of air samples and 100% of exhaust vent samples, with Aspergillus species being the most commonly identified genus. Mucorales were also found in 17% of exhaust vent samples. Aspergillus spp. and Rhizopus spp. showed the highest resistance to Amphotericin B, and a considerable proportion of these isolates exhibited simultaneous resistance to disinfectants. A similar antifungal resistance profile was noted between A. flavus and some R. arrhizus isolates from both environmental and clinical samples.ConclusionsThe findings of this study indicate that the hospital environment, particularly exhaust vents, may act as a significant reservoir for causative agents of IFDs. This highlights the importance of environmental surveillance in preventing and controlling nosocomial fungal infections.