Understanding the mechanisms of resistance to azole antifungals in Candida species

Abstract

Cases of Candida infection have been on the rise in recent years. A comprehensive and clear understanding of the mechanisms of antifungal resistance is fundamental for developing novel therapies to address the current and emerging threat of fungal diseases. Certain Candida species can cause superficial or invasive infections in immunocompromised hosts, and invasive Candida infections are major contributors to infectious disease deaths. As fungi are eukaryotes like humans, there are only a limited number of unique molecular targets available for antifungal drug development. Until recently, there have only been four primary classes of antifungals used to treat systemic fungal infections. Among these, azole antifungals are globally used because they are both inexpensive and effective. Due to various factors, resistance to antifungal drugs-especially azole antifungals-has developed in many Candida species, posing a significant public health threat. This review discusses the known mechanisms of azole antifungal resistance in Candida albicans, Candida auris, Nakaseomyces glabrata, Candida tropicalis, Candida parapsilosis and explores strategies to overcome the resistance problem.