Antifungal Resistance in Invasive Candida and Aspergillus Species: Molecular Mechanisms, Global Epidemiology, and the Emerging Therapeutic Pipeline
Sr No:
Page No:
8-23
Language:
English
Authors:
Njaprim Edward Rihnwi*1, Mukube Kelson Ntuba2
Affiliation:
1*Department of Medical Laboratory Science, Faculty of Health Sciences, University of Bamenda, Cameroon, 2Cameroon Baptist Convention Health Services, Cameroon
Received:
2026-04-03
Accepted:
2026-05-21
Published Date:
2026-06-25
Abstract:
Invasive fungal infections, predominantly caused by Candida and Aspergillus
species, represent a major global mortality burden that is increasingly threatened by escalating
resistance to primary antifungal classes such as azoles, echinocandins, and polyenes. This
convergent crisis is clearly exemplified by the simultaneous global rise of multidrug-resistant
Candida auris and the emergence of pan-azole-resistant Aspergillus fumigatus driven by
environmental agricultural fungicide use. To bridge the gap between isolated resistance
mechanisms and broader epidemiological trends, this review synthesises contemporary data
across four core themes: molecular resistance pathways (including CYP51A, FKS, and ERG11
mutations, alongside efflux and biofilm-associated resistance), the clade-structured transmission
dynamics of C. auris, the environmental selection of azole-resistant A. fumigatus, and the
therapeutic pipeline of novel agents like olorofim, ibrexafungerp, fosmanogepix, and
rezafungin. Ultimately, the manuscript argues that fungal resistance must be managed as a
complex "One Health" systems phenomenon spanning hospitals, farms, and the environment,
requiring harmonised global surveillance, robust stewardship, and a reconceptualisation of
invasive mycoses as a central priority within the global antimicrobial resistance agenda.
Keywords:
Invasive fungal infections; Candida auris; Aspergillus fumigatus; antifungal resistance; CYP51A mutations; echinocandin resistance; novel antifungals.