Candida auris is an emerging yeast that is frequently resistant to antifungal drugs. C. auris can cause invasive infections associated with high mortality and can colonize patients asymptomatically, which facilitates transmission in health care settings. Since it was first reported in the United States in 2016, C. auris has been identified in multiple states, with increasing numbers of cases reported annually. Monitoring national trends in cases identified through clinical testing and screening for colonization is critical to guide infection prevention and control efforts. 2022-2024. State and jurisdictional health departments voluntarily report clinical and screening C. auris cases to CDC using standardized case definitions of the Council of State and Territorial Epidemiologists. Clinical cases are defined as detection of C. auris from specimens collected for diagnostic purposes; screening cases are defined as detection from colonization screening swabs. Cases were reported to CDC through the Research Electronic Data Capture (REDCap) or Data Collation and Integration for Public Health Event Response (DCIPHER) platforms. Data included patient age and sex, case type, specimen type (for clinical cases), health care facility type, Antimicrobial Resistance Laboratory Network geographic region, and specimen collection date. Analyses were descriptive and limited to cases with specimens collected during 2022-2024. During 2022-2024, a total of 13,507 clinical C. auris cases were reported to CDC, increasing from 2,882 in 2022 to 4,428 in 2023 and 6,197 in 2024, with smaller annual percentage increases over time (53.7% from 2022 to 2023 and 39.9% from 2023 to 2024). Most clinical cases occurred among adults aged ≥45 years (87.8%) and among males (61.0%). The most common specimen types among all clinical cases were urine (31.5%) and blood (30.2%); by year, the proportion of blood as the specimen type was 34.4% in 2022, 30.2% in 2023, and 25.6% in 2024. Most clinical cases were identified through specimens collected in acute care hospitals (76.6%) and long-term acute care hospitals (17.8%).During the same period, a total of 27,853 screening cases were reported to CDC, increasing from 6,226 in 2022 to 9,195 in 2023 and 12,432 in 2024. Screening cases most frequently occurred among adults aged ≥45 years (90.0%) and males (57.9%). Among cases with known facility type, the proportion of specimens collected in acute care hospitals increased from 24.7% in 2022 to 50.7% in 2024, whereas the proportion of specimens collected in long-term acute care hospitals decreased from 56.1% to 35.7% during the same period. The number of clinical and screening C. auris cases reported to CDC increased during 2022-2024, indicating ongoing transmission in U.S. health care settings. Although annual percentage increases in clinical cases declined over time, absolute case counts reported to CDC continued to rise. The increasing proportion of screening cases with specimens collected in acute care hospitals might reflect increased use of screening in acute care hospitals, including screening at admission. Because of increases in the number of reported C. auris cases, sustained infection prevention and control efforts in health care facilities, including adherence to transmission-based precautions, environmental disinfection with agents effective against C. auris, and communication of C. auris status during patient transfers remain essential to preventing clinical infections and colonization. Because this pathogen is frequently resistant to antifungal drugs, continued investment in laboratory capacity and surveillance, including antifungal susceptibility testing and screening of patients at high risk for C. auris infection, can support timely detection and guide prevention strategies. Ongoing public health coordination at federal, state, and local levels is critical to limit further spread and to address emerging antifungal drug resistance.

Prevalence of antimicrobial-resistant microorganisms in the NICU environments: Implications for neonatal health.

Transcriptomic profiling reveals long non-coding RNAs correlated with antifungal resistance mechanism against Fusarium verticillioides in infected Zea mays crown root tissue

Candidemia is life-threatening in children. Limited epidemiological and antifungal resistance data for children necessitate national surveillance. This multicenter retrospective study (2016-2024) analyzed 527 pediatric candidemia cases from 13 children's hospitals via the Infectious Disease Surveillance of Pediatrics (ISPED) network. Candida species caused 96.0% (527/549) of fungemia cases. Neonates and infants comprised 51.6% of cases (24.5% neonates and 27.1% infants). Non-albicans Candida species (NACs) dominated (74.0%), with the prevalence of Candida parapsilosis increasing from 21.2% in 2019 to 51.9% in 2024 (Z = 3.11, P = 0.002), while the prevalence of C. albicans decreased from 38.9% to 15.6% during the same period (Z = -2.25, P = 0.024). Azole susceptibility of NACs decreased significantly: C. parapsilosis fluconazole susceptibility decreased from 93.5% (2016-2018) to 63.6% (2022-2024) (P < 0.001), whereas voriconazole (79.5%-93.3%, P = 0.078) and itraconazole (80.0%-97.4%, P = 0.369) susceptibility remained high. Candida tropicalis showed low azole susceptibility, with significant decreases in susceptibility to fluconazole (61.5% in 2016-2018 to 35.0% in 2022-2024) and voriconazole (61.5% in 2016-2018 to 20.0% in 2022-2024; P < 0.001 for all). The susceptibility of wild-type Candida guilliermondii decreased toward fluconazole (100.0% in 2016-2018 and 2019-2021 to 38.9% in 2022-2024), voriconazole (100.0% in 2016-2018 and 2019-2021 to 27.8% in 2022-2024), and itraconazole (100.0% in 2016-2018 and 2019-2021 to 22.2% in 2022-2024) (P < 0.001 for all). All Candida species showed high susceptibility to amphotericin B and echinocandins (99.0% and 95.9%, respectively). Overall, there was a notable shift toward NACs, especially C. parapsilosis, C. tropicalis, and C. guilliermondii, accompanied by declining susceptibility to azoles (particularly in C. tropicalis and C. guilliermondii), which underscores the urgent need for enhanced antifungal stewardship and continuous resistance monitoring.

WHO Global Antimicrobial Resistance Surveillance System (GLASS) for monitoring bloodstream infections due to Candida: findings from a demonstration study.

Background: Vulvovaginal candidiasis (VVC) is a common infection affecting millions of women, with Candida species capable of shifting from commensal to pathogenic states through various virulence factors. Rising antifungal resistance, driven by extensive drug use and limited therapeutic options, further complicates management. So, this study aimed to investigate prevalence of different Candida species and their antifungal resistance profiles, detect virulence and resistance genes and evaluate the relationship between virulence and resistance patterns in Candida species isolated from women with VVC in Assiut University. Methodology: 125 vaginal swabs were cultured on Sabouraud’s Dextrose agar. Identification and antifungal susceptibility testing of Candida spp. by VITEK ® 2 were done. Virulence and resistance genes as INT1, CPH1, ALS1, HWP1, SAP1, SAP2, PLP, CDR1, and MDR1 were detected by PCR. Results: Forty Candida isolates were obtained. C. albicans was the most prevalent species, followed by C. Ciferrii, C. tropicalis, C. glabrata and C. dubilinesis, while one isolate of each of C. haemulonii, C. inconspicua, C. krusei, C. rugosa and Cryptococcus laurentii was detected. All isolates were sensitive to voriconazole, micafungin and amphotericin B except 15 C. albicans and 2 C. tropicalis isolates resistant to fluconazole, one isolate of C. albicans resistant to caspofungin and one isolate of each of C. glabrata, C. dubilinesis and C. krusei resistant to flucytosine. All genes were detected at variable frequencies. Conclusion: High susceptibility rates were observed for voriconazole, amphotericin B, caspofungin, and flucytosine, while azole resistance remained prevalent. Co-expression of virulence and resistance genes in several isolates underscores the dual challenge posed by these strains.

Culture-proven osteoarticular mycoses: An eight-year single-center descriptive study of fungal distribution and antifungal susceptibility trends.

Sexually transmitted infections (STIs) remain a global health burden. Beyond classical pathogens, dermatophytes are increasingly identified within sexually linked transmission networks. Genital dermatophytosis is a superficial fungal infection of the genital area, primarily caused by anthropophilic and zoophilic dermatophytes. Recently, Trichophyton mentagrophytes genotype VII and Trichophyton indotineae have emerged as clinically significant dermatophytes, increasingly linked to human-to-human and sexually associated transmission within highly interconnected sexual networks. These infections are often marked by inflammatory, persistent, and treatment-refractory presentations, with prominent genital involvement and rising antifungal resistance—particularly to terbinafine—posing growing diagnostic and therapeutic challenges. Doxycycline post-exposure prophylaxis (Doxy-PEP) has recently emerged as a novel preventive strategy for bacterial STIs, involving the administration of 200 mg doxycycline within 24–72 h after activities associated with increased infection exposure, particularly among men who have sex with men (MSM) and transgender women. While effective in reducing infections such as syphilis and chlamydia, its broader implementation raises concerns regarding antimicrobial resistance. Chemsex is an increasingly prevalent behavioural phenomenon, defined as the intentional use of psychoactive substances during sexual activity to enhance or prolong the experience, particularly among MSM. It is associated with multiple adverse effects, including increased STI transmission, substance dependence, drug toxicity, psychological disturbances, and significant challenges in treatment adherence and healthcare engagement. This review aims to provide a comprehensive and clinically oriented overview of emerging trends in STIs, with a particular focus on dermatophyte infections as pathogens with potential sexually associated transmission, alongside evolving prevention strategies and behavioral factors influencing transmission.

Vulvovaginal candidiasis (VVC) is a prevalent mucosal infection primarily caused by Candida albicans, affecting up to 75% of women of reproductive age. VVC therapeutic management is increasingly challenged by antifungal resistance, host toxicity, and high recurrence rates. Lactobacillus species, the dominant members of healthy vaginal microbiota, are known to antagonize pathogens and maintain mucosal homeostasis by producing antimicrobial metabolites and modulating epithelial responses. However, few studies have explored the antagonistic and anti-virulence properties of Lactobacillus strains isolated from asymptomatic women, particularly their activity against clinical C. albicans isolates. This study aimed to characterize vaginal Lactobacillus strains and their cell-free supernatants (CFS) isolated from asymptomatic women and evaluate their antifungal and anti-virulence activities against clinical isolates of C. albicans. Forty-two clinical Lactobacillus isolates were identified, of which eight inhibited the growth of the tested pathogens. However, among the clinical isolates, only L. fermentum JAC 231 and Lactiplantibacillus plantarum MDBL 269 inhibited all the fungal isolates tested. Based on these results, L. fermentum ATCC 23271 (positive control) and the clinical strains L. fermentum JAC 231 and L. plantarum MDBL 269 were selected for detailed analyses of their ability to interfere with key virulence factors of C. albicans, including hyphal morphogenesis, biofilm formation and disruption, adhesion, and the secretion of extracellular enzymes. The selected strains and their CFS displayed antagonistic activity: they reduced pathogen adhesion, co-aggregated with yeast cells, impaired biofilm formation, and destabilized preformed biofilms. In addition, whole-genome sequencing combined with antimicrobial peptide gene-cluster prediction using BAGEL4 and antiSMASH revealed two biosynthetic gene clusters in L. fermentum JAC 231 and seven in L. plantarum MDBL 269, providing a plausible genetic basis for the antimicrobial effects observed.

Oral candidiasis (OC) is among the most prevalent oral infections, frequently associated with immunosuppression, denture wearing, advanced age, and excessive antibiotic use. Given the growing concerns about antifungal resistance, probiotics are being explored as potential adjuncts in the management of oral Candida overgrowth. Existing literature provides fragmented evidence; thus, an umbrella review was planned to synthesize the available evidence on the effectiveness of probiotic interventions in reducing oral Candida spp. A comprehensive, independent search was conducted in four databases (PubMed, Embase, Scopus, and Web of Science) covering literature from inception to 31st January 2026. Systematic reviews (SRs) with or without meta-analyses (MAs) assessing the effectiveness of probiotics in reducing oral Candida spp. count in terms of colony-forming units/mL (CFU/mL) were included. The quality assessment of the evidence was evaluated using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Out of the 157 retrieved records, 7 studies were included in this umbrella review, out of which 5 were SRMAs, and 2 were SRs. The interventions involved multi-strain probiotics delivered through various formulations, routes, and treatment durations. Across the 5 SRMAs, probiotic interventions demonstrated beneficial effects by reducing Candida spp. with effect estimates ranging from odds ratio (OR) 0.06 to 0.71; however, wide interstudy heterogeneity (I2 = 0-78%) restricts the reliability and comparability of these findings. These effect estimates were derived from individual meta-analyses with heterogeneous study populations. Methodological assessment of the 7 included studies using the AMSTAR 2 tool identified 3 studies (42.8%) as having low confidence, while 4 studies (57.1%) were rated critically low. Similarly, the overall quality of evidence, as assessed by GRADE, ranged from low for the adult population to very low for the pediatric population, across three key clinical outcomes: reduction in oral Candida spp., clinical cure rate of OC, and recurrence rate. Probiotics may have a potential role in the prevention and treatment of OC; however, the current evidence base cannot be generalized due to significant heterogeneity and methodological constraints. Probiotics can supplement conventional antifungal treatment, but their standalone use is not recommended yet. High-quality, standardized randomized controlled trials and comprehensive SRMAs are necessary to better understand the effectiveness of probiotics in OC management. PROSPERO CRD420251117392.

Since its 2009 emergence, Candida auris (now also known as Candidozyma auris) has evolved from a rare isolate into a global "critical priority" pathogen. This rapid expansion is defined by its unique population structure consisting of six distinct genomic clades with starkly different evolutionary trajectories, phenotypic traits, and clinical risks. We conducted a systematic synthesis of literature from PubMed, Scopus, and Google Scholar (2009-2026), focusing on comparative genomics, clade-specific virulence, and diagnostic accuracy. A total of 64 studies were analyzed to identify patterns in clade divergence and antifungal resistance. Our analysis reveals that C. auris is not a monolithic threat but a complex of diverse lineages with specialized adaptations. Clade I (South Asian) and Clade IV (South American) represent the highest clinical risk due to hyper-virulence and high rates of multi-drug resistant (MDR) strains. In contrast, Clade II (East Asian) was initially associated with localized ear infections; recent genomic data show an expanding pathogenic profile with emerging bloodstream infections. Our review also identifies Clade V (Iranian) as a genetically distinct group and highlights the recent identification of Clade VI (Indomalayan) as a distinct lineage, suggesting a long-standing environmental reservoir. Furthermore, we identify critical "blind spots" in automated diagnostic platforms (VITEK® 2, BD Phoenix) where phenotypic variations in Clades II and III lead to frequent misidentification as Candida haemulonii or Candida famata. This review proposes a "clade-aware" framework for public health. While frontline antifungal treatment remains standardized regardless of lineage, we argue that effective long-term management and outbreak containment require integrating genomic surveillance with clade-specific infection control. By identifying high-biofilm clades (Clade I) or hyper-virulent lineages (Clade IV), public health systems can implement more targeted containment strategies, moving toward a precision-based approach to managing this fungal pathogen.

Fonsecaea monophora is a dematiaceous fungus with worldwide distribution that can cause chromoblastomycosis, an implantation mycosis and a neglected tropical disease. F. monophora also causes phaeohyphomycosis, including central nervous system infections like brain abscesses, with high mortality rates. In the absence of clinical breakpoints, epidemiological cutoff values (ECVs) can aid clinicians in monitoring antifungal resistance trends and guide initial antifungal selection. To establish F. monophora MIC distribution and ECVs, we performed antifungal susceptibility testing (AFST) on F. monophora isolates. AFST data on F. monophora isolates were collected at 14 laboratories during September 2023-May 2026. Species identification was previously confirmed by DNA sequence analysis. AFST was performed by CLSI M38 standard broth microdilution method for itraconazole, voriconazole, posaconazole, isavuconazole, ketoconazole, terbinafine, flucytosine, and amphotericin B. The ECVs were established using the iterative statistical method with ECOFFinder (v2.1) following CLSI M57 guidelines. We analyzed MIC results from 137 F. monophora isolates. The calculated ECVs were itraconazole, 2 μg/mL; voriconazole, 0.25 μg/mL; posaconazole, 1 μg/mL; isavuconazole, 0.25 μg/mL; and terbinafine, 0.5 μg/mL. Amphotericin B and flucytosine had bimodal distributions, and no ECVs were set. Ketoconazole did not have data from ≥100 isolates. These F. monophora ECVs can detect non-wild-type isolates to reevaluate antifungal treatment and investigate treatment failure associated with potential clinical resistance. Established through a global multicenter collaboration, these values provide a baseline to better understand the in vitro antifungal susceptibility profile of this species and monitor resistance.IMPORTANCEFonsecaea monophora is a dematiaceous fungus with worldwide distribution that can cause chromoblastomycosis, an implantation mycosis and neglected tropical disease of the skin and subcutaneous tissue. F. monophora also causes phaeohyphomycosis, including central nervous system infections like brain abscesses with high mortality rates. The paucity of antifungal susceptibility testing data on F. monophora complicates interpretation of minimum inhibitory concentration (MIC) values. We performed antifungal susceptibility testing on 137 F. monophora isolates to establish MIC distributions and epidemiological cutoff values (ECVs) for eight antifungals, including those commonly used to treat F. monophora infections. The calculated ECVs for commonly used antifungals were 2 μg/mL for itraconazole, 0.25 μg/mL for voriconazole, 1 μg/mL for posaconazole, and 0.5 μg/mL for terbinafine. ECVs can assist in selecting potential treatments for F. monophora and tracking antifungal resistance trends.

Dermatophytosis remains one of the most prevalent superficial fungal infections worldwide and is increasingly encountered as a persistent or difficult-to-treat syndrome. A major clinical problem is that apparent treatment failure is often attributed to antifungal resistance, although many cases are instead driven by diagnostic uncertainty, corticosteroid-modified disease, reinfection, inadequate exposure, poor adherence, and limited drug delivery within keratinized tissues. This narrative review was developed to clarify the distinction between true antifungal resistance and clinical recalcitrance, with particular attention to terbinafine-resistant Trichophyton species, Trichophyton indotineae, tinea incognito, onychomycosis, dermatophytoma, and high-barrier skin and nail infections. We synthesized peer-reviewed literature and guideline-level evidence addressing epidemiology, molecular mechanisms of resistance, clinical phenotypes of recalcitrance, diagnostic escalation, therapeutic decision-making, and antifungal delivery in keratinized tissues. The review contributes a dermatology-centered conceptual framework in which persistent dermatophytosis is interpreted through both microbiological resistance and modifiable recalcitrance drivers. This approach emphasizes confirmation of fungal disease when indicated, phenotypic and anatomic classification, avoidance of inappropriate corticosteroid combinations, optimization of dose, duration, vehicle, and adherence, measures to improve drug access and reduce protected fungal burden in high-barrier disease, and prevention of reinfection from reservoirs. The proposed framework may support more rational antifungal use and reduce unnecessary escalation; however, it is based on narrative synthesis rather than a systematic review or prospective validation. Additional studies are needed to determine how such structured clinical approaches affect clinical outcomes, relapse rates, antifungal exposure, and resistance emergence in real-world dermatology practice.

Fungal skin infections represent a significant global health burden, affecting approximately one billion people annually. Despite their prevalence and major global health impact, the molecular mechanisms underlying pathogenicity remain largely uncharacterized. Here we present the genomes of 66 fungal strains, representing highly prevalent and clinically relevant species associated with human skin infections. Using comparative genomics, we investigate whether the taxonomic groups in this collection of skin fungi differ in their genome architecture, metabolic capacity, secreted enzyme repertoires, adhesin content, and predicted virulence determinants. These analyses reveal substantial variation in genome size and gene contents, indicating genome compaction occurred as the fungi transitioned from free-living to host-associated lifestyles. We report two non-hybrid strains of Trichosporon ovoides, the causative agent of white piedra. Our analyses reveal substantial differences in metabolic adaptations across skin-associated fungi, corresponding to body-site and nutrient niches. Significant differences are also observed in the distribution of virulence factors and adhesins, which are imperative for biofilm formation and antifungal resistance. We discuss metabolic adaptation and virulence mechanisms revealed by our data in the context of clinical presentations, highlighting shared and lineage-specific signatures of adaptations. Together, these insights advance our understanding of skin-associated fungi and their mechanisms of infection.

Invasive fungal diseases (IFDs) remain an important cause of morbidity and mortality among immunocompromised children. Changes in diagnostic criteria and increasing use of antifungal prophylaxis may influence the epidemiology and clinical presentation of pediatric IFDs. Longitudinal data from Southeast Asia remain limited. This study aimed to characterize temporal trends, clinical features, and outcomes of pediatric IFDs using the 2020 EORTC/MSGERC criteria. We retrospectively reviewed children aged 0-15 years diagnosed with IFDs at a tertiary-care hospital in Bangkok, Thailand, from 2014 to 2023. IFD episodes were classified as proven, probable, or possible according to the 2020 EORTC/MSGERC criteria and categorized by causative organism. Temporal trends, clinical characteristics, antifungal prophylaxis exposure, and outcomes were analyzed. Among 156 patients, 171 IFD episodes were identified: invasive aspergillosis (60 episodes), invasive candidiasis (61), Pneumocystis pneumonia (33), cryptococcosis (5), other invasive mold infections (8), and endemic mycoses (4). Invasive aspergillosis and Pneumocystis pneumonia demonstrated greater year-to-year variability with higher case numbers in later years, whereas invasive candidiasis occurred consistently throughout the study. A proportion of IFD episodes occurred despite antifungal prophylaxis, including 23.3% of invasive aspergillosis, 8.2% of invasive candidiasis, and 12.1% of Pneumocystis pneumonia. Hematologic malignancies were the most common underlying conditions among children with invasive aspergillosis (68.3%) and Pneumocystis pneumonia (27.3%). Invasive candidiasis primarily affected infants and young children with chronic conditions, including chronic liver or gastrointestinal disease (25.4%) and congenital heart disease (25.4%), and was strongly associated with central venous catheter use (88.9%). Candida albicans remained the most common pathogen, with overall low antifungal resistance. The clinical manifestations were non-specific and overlapped across pathogens, most commonly presenting with fever and organ-specific symptoms. Ninety-day all-cause mortality was 20.3% for aspergillosis, 24.8% for candidiasis, and 12.9% for Pneumocystis pneumonia. Pediatric IFDs remained associated with substantial mortality despite evolving diagnostic criteria and increasing use of antifungal prophylaxis, underscoring the need for improved diagnostic and preventive strategies.

Aneuploidy promotes transient stress adaptation and metabolic flexibility in the human fungal pathogen Aspergillus fumigatus.

Pediatric candidemia is a major cause of invasive fungal infections in hospitalized children, but long-term data on epidemiology, management, and mortality predictors remain limited. We conducted an 18-year retrospective cohort study of 465 pediatric candidemia episodes at a tertiary referral center in western Turkey between 2008 and 2025. The primary outcome was crude 30-day mortality; associated factors were assessed using univariable analyses, Kaplan-Meier estimates, and multivariable logistic regression. Non-albicans Candida species predominated, with Candida parapsilosis as the most frequent isolate (46%). Central venous catheters were present in 88.4% of episodes. Crude 30-day mortality was 10.8%. Reduced survival was observed among patients without catheter removal and among those with thrombocytopenia, severe neutropenia, or immunosuppressive therapy. Among 341 episodes classified as central line-associated bloodstream infections, crude 30-day mortality differed significantly by catheter removal timing. Mortality was 4.8% with catheter removal within 72 h versus 13.1% without early removal (p = 0.022). Using a 48 h threshold, mortality was 3.1% with removal within 48 h versus 12.3% without removal within 48 h (p = 0.029). In multivariable analysis, failure to remove the catheter was the strongest independent factor associated with mortality (adjusted odds ratio, 6.63; 95% confidence interval, 2.85-15.42; p < 0.001). Antifungal resistance patterns were not consistently associated with mortality. In this large pediatric candidemia cohort, 30-day mortality was mainly associated with host vulnerability and modifiable management factors, underscoring the importance of timely source control.

Vulvovaginal candidiasis (VVC) is a common fungal infection in women, primarily caused by Candida species. Biofilm formation is a key virulence factor contributing to pathogenicity and antifungal resistance. This study aimed to identify Candida species, evaluate antifungal susceptibility, quantify biofilm formation, and detect virulence gene markers (ALS1 and HWP1) in vaginal isolates from women with VVC. A cross-sectional study was conducted from December 2021 to June 2024 among 400 women attending obstetrics and gynecology clinics in Sana'a City. Vaginal swabs were collected and cultured in a microbiology laboratory. Antifungal susceptibility of isolates to nystatin, voriconazole, fluconazole, ketoconazole, clotrimazole, miconazole, itraconazole, and amphotericin B was assessed using the disk diffusion method. Biofilm formation was measured using the microtiter plate assay. The presence of ALS1 and HWP1 genes was determined by PCR. Data were analyzed using SPSS version 20, and associations were evaluated with the Chi-square test; P < .05 was considered statistically significant. C. albicans was identified in 367 (91.8%) isolates, while non-albicans species accounted for 33 (8.2%). Of the 367 C. albicans isolates, 174 (47.4%) formed biofilms: 32 (8%) strong, 72 (18%) moderate, and 70 (17.5%) weak. Biofilm- forming isolates were associated with higher antifungal resistance, with amphotericin B (113; 64.9%) and itraconazole (108; 62.1%) showing the highest resistance, and nystatin the lowest (23; 13.2%). The ALS1 gene was detected in all biofilm- forming C. albicans isolates (174; 100%), while HWP1 was present in 82 (47.1%). Non-biofilm-forming isolates demonstrated lower resistance rates across all drugs. VVC remains highly prevalent in Sana'a, Yemen, with C. albicans as the dominant pathogen. These findings suggest a potential association between biofilm formation and increased antifungal resistance also the presence of key virulence genes-particularly ALS1 and HWP1. However, due to the study's cross-sectional design, a definitive causal relationship cannot be inferred. This study emphasizes the importance of integrating phenotypic and molecular characterization into routine diagnostics and surveillance to improve the management of resistant Candida infections. Continuous monitoring of species distribution is also warranted to detect emerging non-albicans species.

The global rise in multidrug-resistant (MDR) fungal pathogens has positioned Candida auris and Candida glabrata as major threats to public health. In recent years, these pathogens have increasingly been reported beyond traditional hospital settings, including neonatal intensive care units, long-term care facilities, oncology wards, and post-pandemic critical care environments. International surveillance bodies, including the Centers for Disease Control and Prevention (CDC), European Centre for Disease Prevention and Control (ECDC), World Health Organization (WHO), and regional monitoring networks, have documented escalating antifungal resistance, complex outbreak dynamics, and persistent gaps in infection control implementation. C. auris has emerged as a major etiological agent of healthcare-associated outbreaks, particularly in intensive care and neonatal units. Surveillance data indicate that a high proportion of C. auris isolates exhibit resistance to azoles, often exceeding 80% in some regions, while echinocandin resistance remains variable. Resistance patterns have evolved from predominantly azole resistance to broader multidrug-resistant phenotypes, including treatment-emergent echinocandin resistance. Six genetically distinct clades (I-VI) have been identified, with Clades I, III, and IV associated with large-scale outbreaks, whereas available data suggests that Clades II, V, and VI are more geographically restricted, although evidence for the recently described clades remains limited. C. glabrata is increasingly recognized as a major cause of invasive candidiasis, with rising resistance reported across multiple regions. While reduced azole susceptibility was historically predominant, emerging evidence highlights rising dual azole-echinocandin resistance, adaptive microevolution during antifungal therapy, and biofilm-associated tolerance mechanisms. Despite these advances, significant gaps persist in global resistance surveillance and in the mechanistic understanding of virulence and antifungal adaptation. Current mitigation strategies include antifungal stewardship programs, expanded resistance testing, and strengthened surveillance systems. Advances in rapid diagnostic technologies such as matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry, polymerase chain reaction (PCR)-based assays, and genomic surveillance have improved pathogen identification and outbreak detection, although accessibility remains limited in resource-constrained settings. This review examines emerging epidemiological, genomic, and antifungal resistance trends in C. auris and C. glabrata and highlights key priorities for improving diagnosis, surveillance, stewardship, and management of multidrug-resistant Candida infections.

Objectives: When a Candida species is identified in an ICU patient, susceptibility results are typically available in 24-72 h. In this study, we built a machine learning model using four variables available at identification to estimate resistance probability in real time. Methods: We analysed 747 fungal isolates from 725 ICU patients (January 2021-March 2026). We trained and compared a Random Forest and a Logistic Regression model, evaluating both with temporal cross-validation, permutation feature importance, three-category (S/I/R) prediction, and calibration analysis. Results: Multidrug resistance doubled from 24.5% (2021) to 51.1% (2025), and Candida auris grew eight-fold in three years. Random Forest reached AUC 0.885 on the held-out test set and 0.848 on prospective 2024-2025 data (Brier score 0.093). Species identity and drug choice together explained 87% of predictive signal. Local C. albicans fluconazole resistance (~16%) far exceeded the ECMM European figure of 0%, and C. krusei was four times more prevalent than the continental average. Conclusions: A four-variable model may provide calibrated resistance estimates during the critical gap before susceptibility results return, though performance reflects predominantly deterministic species-drug patterns rather than complex learned biology. Overall performance was comparable to a rule-based lookup table, confirming that the majority of predictive signal derives from established species-drug susceptibility patterns. Meaningful added value is limited to temporal trend tracking and improved prediction where resistance is acquired rather than intrinsic (C. albicans, C. tropicalis hard-subset AUC 0.929 vs. rule-based 0.899). The model complements a local antifungal testing; it does not replace one.