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Global prevalence of multidrug-resistant Candida auris in humans between 2015 and 2024: A systematic review and
Conrad C Achilonu1, Will J Barwatt1, Theodore J Kottom1
1Thoracic Diseases Research Unit, Departments of Medicine and Biochemistry, Mayo Clinic, Rochester, MN 55905, USA.
Abstract:
Candida auris is an emerging fungal pathogen with high rates of multidrug resistance, posing a significant global health threat. Immunosuppressed patients are particularly vulnerable to multidrug-resistant (MDR) C. auris infections. This systematic review and meta-analysis (SR-MA) aimed to assess the global prevalence of MDR-C. auris isolates in humans and their resistance to antifungal drugs, primarily fluconazole (FLZ), voriconazole (VOR), and amphotericin B (AmB). A comprehensive search was conducted in PubMed, Scopus, and ScienceDirect databases on published studies regarding clinical C. auris isolates and the use of antifungal susceptibility testing assay from 17 March 2015 to 1 February 2024. Meta-analysis was conducted using random-effects models to determine the estimated pooled prevalence of MDR-C. auris isolates and their antifungal resistance profiles from immunosuppressed humans. A total of 81 research studies were included in the final analysis, with the overall pooled prevalence of the three most important antifungal drugs; FLZ (92.5% | 95% CI: 89.5-94.7), VOR (49.0% | 95% CI: 37.6-60.4), and AmB (51.0% | 95% CI: 42.3-59.7). According to the subgroup analyses, FLZ-resistant C. auris was the most prevalent isolate observed in the five continents reporting compared to the VOR- and AmB-resistant C. auris having lower pooled prevalence. Further, higher pooled prevalence of MDR-C. auris isolates were observed from males (68.2%, n = 578) compared to females (37.1%, n = 283). Finally, the global pooled prevalence for mortality in immunosuppressed patients with MDR-C. auris from 13 research studies was 41.5% (95% CI: 29.9-54.2). This SR-MA study establishes the variation of MDR-C. auris resistance patterns observed from different continents and the importance to conduct further research studies using potent antifungal drugs. Accordingly, it is imperative to establish stringent surveillance on the increasing prevalence of antifungal resistance particularly in low-income regions with limited research resources to prevent increasing prevalence of MDR-C. auris.
Insights
Multidrug-resistant Candida auris (MDR-C. auris) is a global health threat, especially for immunosuppressed individuals. This review found high resistance rates to fluconazole, voriconazole, and amphotericin B, with significant mortality in infected patients.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Public Health
Background:
- Candida auris is an emerging, multidrug-resistant (MDR) fungal pathogen.
- It poses a significant global health threat, particularly to immunosuppressed patients.
- MDR C. auris infections are associated with high mortality rates.
Purpose of the Study:
- To systematically review and meta-analyze the global prevalence of MDR C. auris in humans.
- To assess the resistance patterns of MDR C. auris to key antifungal drugs: fluconazole (FLZ), voriconazole (VOR), and amphotericin B (AmB).
- To determine the pooled prevalence of mortality in immunosuppressed patients with MDR C. auris infections.
Main Methods:
- A comprehensive literature search was conducted in PubMed, Scopus, and ScienceDirect databases.
- Studies published between March 2015 and February 2024, focusing on clinical C. auris isolates and antifungal susceptibility testing, were included.
- Meta-analysis using random-effects models was performed on 81 research studies.
Main Results:
- The pooled prevalence of resistance was high for FLZ (92.5%), VOR (49.0%), and AmB (51.0%).
- FLZ-resistant C. auris was the most prevalent isolate globally.
- The global pooled prevalence for mortality in immunosuppressed patients with MDR C. auris was 41.5%.
Conclusions:
- Significant variations in MDR C. auris resistance patterns exist across continents.
- Further research on potent antifungal drugs is crucial.
- Stringent surveillance of antifungal resistance, especially in low-resource regions, is imperative to curb the spread of MDR C. auris.
