da Silva Kássia Jéssica Galdino, Lucini Fabíola, Dos Santos Renato Augusto Corrêa, Santos Daniel Assis, Meis Jacques F, Melhem Marcia de Souza Carvalho, Peres Nalu Teixeira de Aguiar, Bastos Rafael Wesley, Rossato Luana
Centro de Biociências, Universidade Federal do Rio grande do Norte (UFRN), Natal, Rio Grande do Norte, Brazil.
Health Sciences Research Laboratory, Universidade Federal da Grande Dourados (UFGD), Dourados, Mato Grosso do Sul, Brazil.
Clin Microbiol Infect. 2025 Jul;31(7):1146-1156. doi: 10.1016/j.cmi.2025.04.003. Epub 2025 Apr 9.
Candida (Candidozyma) auris is a multidrug-resistant yeast that emerged as a significant health care-associated pathogen. It is classified as an urgent threat to public health due to the high resistance to available antifungal agents. Globally six distinct clades of C. auris have been identified with varying antifungal susceptibility patterns and geographical distributions.
The aim of this review is to investigate the (published) antifungal susceptibility profiles of different C. auris clades to identify those with a higher prevalence of resistance.
A comprehensive literature review was conducted using PubMed, SciELO, Google Scholar, and MEDLINE databases to collect data on MIC distributions and clade designations of C. auris strains.
A total of 1031 C. auris strains were included. Clades I and III, which are closely related phylogenetically, displayed the highest resistance rates, particularly to fluconazole, with 94% and 96% of isolates, respectively. Clade IV also exhibited resistance to both azoles and echinocandins. In contrast, clades II, V, and VI had lower resistance rates, with clade VI being entirely susceptible to fluconazole. Anidulafungin demonstrated the greatest efficacy across all clades, with resistance rates ranging from 0% to 3.67%. Furthermore, clades V and VI showed complete susceptibility to all antifungal agents evaluated.
This study highlights significant variations in antifungal resistance profiles across the six C. auris clades. Clades I, III, and IV stand out because of their multidrug resistance, particularly to fluconazole and amphotericin B, posing serious challenges for treatment. Continuous global surveillance and tailored management strategies are essential for controlling C. auris infections, especially in highly resistant clades. Enhanced diagnostic capabilities and further genomic studies are critical to understanding the evolving nature of resistance in this emerging pathogen and improving therapeutic outcomes. Clade-specific antifungal resistance in C. auris requires monitoring to optimize therapy selection during outbreaks.
耳念珠菌（念珠假丝酵母）是一种多重耐药酵母，已成为一种重要的医疗保健相关病原体。由于对现有抗真菌药物具有高度耐药性，它被列为对公众健康的紧急威胁。全球已鉴定出六种不同的耳念珠菌进化枝，它们具有不同的抗真菌药敏模式和地理分布。
本综述的目的是研究不同耳念珠菌进化枝的（已发表的）抗真菌药敏谱，以确定耐药性较高的进化枝。
使用PubMed、SciELO、谷歌学术和MEDLINE数据库进行了全面的文献综述，以收集耳念珠菌菌株的最低抑菌浓度（MIC）分布和进化枝分类数据。
共纳入1031株耳念珠菌菌株。在系统发育上密切相关的进化枝I和III显示出最高的耐药率，尤其是对氟康唑，分别有94%和96%的分离株耐药。进化枝IV对唑类和棘白菌素类也表现出耐药性。相比之下，进化枝II、V和VI的耐药率较低，进化枝VI对氟康唑完全敏感。阿尼芬净在所有进化枝中显示出最大的疗效，耐药率在0%至3.67%之间。此外，进化枝V和VI对所有评估的抗真菌药物均表现出完全敏感性。
本研究突出了六种耳念珠菌进化枝在抗真菌耐药谱方面的显著差异。进化枝I、III和IV因其多重耐药性，特别是对氟康唑和两性霉素B的耐药性而突出，给治疗带来了严峻挑战。持续的全球监测和量身定制的管理策略对于控制耳念珠菌感染至关重要，尤其是在高度耐药的进化枝中。增强诊断能力和进一步的基因组研究对于理解这种新兴病原体耐药性的演变性质和改善治疗结果至关重要。耳念珠菌进化枝特异性的抗真菌耐药性需要监测，以便在疫情暴发期间优化治疗选择。
