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Updated: Sep 11, 2025
Whole Genome Sequencing of Candida glabrata for Detection of Markers of Antifungal Drug Resistance
Published on: December 28, 2017
Clinical impact of fluconazole-resistant Candida parapsilosis: a narrative review
Claudia Bartalucci1,2, Antonio Vena1,2, Daniele Roberto Giacobbe1,2
1Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
Abstract:
Fluconazole resistance in Candida parapsilosis is an increasing global concern, with resistance rates varying widely and reaching up to 80% in some regions. This trend has led to hospital outbreaks, primarily driven by mutations in the ERG11 gene, especially the Y132F substitution. The clinical relevance of fluconazole resistance remains controversial, as studies have yielded conflicting results regarding its impact on mortality. While some studies described an increased mortality associated with resistant strains, others reported no significant difference. Treatment options are limited: echinocandins and liposomal amphotericin B (L-AmB) are commonly used alternatives, but their use is challenged by intrinsic and emerging echinocandin resistance and L-AmB toxicity and cost. These limitations emphasize the need for robust antifungal stewardship and the development of new therapies. Novel agents such as rezafungin, fosmanogepix, and ibrexafungerp have shown promising activity against fluconazole-resistant C. parapsilosis, though further clinical studies are needed to confirm their efficacy. This narrative review aims to summarize current evidence on the epidemiology, clinical implications, and therapeutic approaches for fluconazole-resistant C. parapsilosis infections.
Insights
Fluconazole resistance in Candida parapsilosis is rising globally, driven by ERG11 gene mutations. Limited treatment options and controversial clinical outcomes necessitate new antifungal strategies.
Area of Science:
- Mycology
- Infectious Diseases
- Antimicrobial Resistance
Background:
- Fluconazole resistance in Candida parapsilosis is a growing global health issue.
- Resistance rates vary significantly by region, reaching up to 80% in some areas.
- Mutations in the ERG11 gene, particularly Y132F, are primary drivers of this resistance.
Purpose of the Study:
- To review the current evidence on the epidemiology of fluconazole-resistant Candida parapsilosis.
- To discuss the clinical implications and impact on patient mortality.
- To summarize existing and emerging therapeutic strategies for these infections.
Main Methods:
- This study is a narrative review.
- It synthesizes information from existing literature on fluconazole resistance in Candida parapsilosis.
- The review covers epidemiology, clinical relevance, and treatment options.
Main Results:
- Fluconazole resistance in Candida parapsilosis is increasing, linked to ERG11 mutations.
- The impact of resistance on mortality is debated, with conflicting study results.
- Current alternative treatments like echinocandins and liposomal amphotericin B have limitations.
Conclusions:
- There is a critical need for improved antifungal stewardship.
- Development of novel antifungal agents is essential.
- Emerging therapies show promise but require further clinical validation.
