Worldwide emergence of fluconazole-resistant Candida parapsilosis: current framework and future research roadmap
Open accessAbstract
Candida parapsilosis is one of the most commen causes of life-threatening candidaemia, particularly in premature neonates, individuals with cancer of the haematopoietic system, and recipients of organ transplants. Historically, drug-susceptible strains have been linked to clonal outbreaks. However, worldwide studies started since 2018 have reported severe outbreaks among adults caused by fluconazole-resistant strains. Outbreaks caused by fluconazole-resistant strains are associated with high mortality rates and can persist despite strict infection control strategies. The emergence of resistance threatens the efficacy of azoles, which is the most widely used class of antifungals and the only available oral treatment option for candidaemia. The fact that most patients infected with fluconazole-resistant strains are azole-naive underscores the high potential adaptability of fluconazole-resistant strains to diverse hosts, environmental niches, and reservoirs. Another concern is the multidrug-resistant and echinocandin-tolerant C parapsilosis isolates, which emerged in 2020. Raising awareness, establishing effective clinical interventions, and understanding the biology and pathogenesis of fluconazole-resistant C parapsilosis are urgently needed to improve treatment strategies and outcomes.
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The proportion of C. parapsilosis has increased in Asia (including Japan and China), Latin America (including Brazil), and Southern Europe.
“Comparatively, the proportion of C. parapsilosis has increased in Asia (including Japan and China), Latin America (including Brazil) and Southern Europe,31,62–65”
From Epidemiology of Invasive Candidiasis (2024) · cites this paper as [64]
The ‘C parapsilosis epidemiology and infection risk factors’ section reports a high proportion of C. parapsilosis among Candida blood-culture isolates in China, Brazil, Spain and other countries in the named regions (page not available). It does not establish that this proportion increased over time in those regions, and it does not give a proportion for Japan. Its report of increasingly documented outbreaks is not the same as an increasing proportion of C. parapsilosis. (LLM, conf=0.83)
Experimental — accuracy not yet measuredOver 50% of C. parapsilosis isolates are resistant to fluconazole in some series.
“However, fluconazole resistance has emerged over the last decade and over 50% of C. parapsilosis isolates are resistant in some series.64,119”
From Epidemiology of Invasive Candidiasis (2024) · cites this paper as [64]
The Burden of fluconazole-resistant C parapsilosis section reports that resistant strains emerged and outcompeted susceptible isolates in some health-care settings. It does not give a resistance rate above 50% for a series of isolates; its explicit prevalence statement is more than 10% in many areas before 2019. (LLM, conf=0.82)
Experimental — accuracy not yet measuredThese properties allow fluconazole-resistant C. parapsilosis, which is associated with high mortality rates among those infected, to be a viable threat to widescale spread.
“These properties allow this pathogen, which is associated with high mortality rates among those infected,64 a viable threat to widescale spread.”
From Epidemiology of Invasive Candidiasis (2024) · cites this paper as [64]
A concerning worldwide increase of clonal outbreaks caused by fluconazole-resistant C. parapsilosis is ongoing.
“While not an emergent species, a concerning worldwide increase of clonal outbreaks caused by fluconazole-resistant C. parapsilosis is ongoing.”
From Epidemiology of Invasive Candidiasis (2024) · cites this paper as [64]
Fluconazole-resistant C. parapsilosis strains that carry the ERG11 Y132F mutation may not suffer an associated fitness cost and may therefore thrive even in the absence of triazole exposure.
“Fluconazole-resistant C. parapsilosis strains that carry the ERG11 Y132F mutation may not suffer an associated fitness cost (potentially a survival benefit), and may, therefore, thrive even in the absence of triazole exposure.64”
From Epidemiology of Invasive Candidiasis (2024) · cites this paper as [64]
Fluconazole resistance in C. parapsilosis has emerged over the last decade.
“However, fluconazole resistance has emerged over the last decade and over 50% of C. parapsilosis isolates are resistant in some series.64,119”
From Epidemiology of Invasive Candidiasis (2024) · cites this paper as [64]
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References 72 · Cited by 257
Research works printed but not linked: 1
- [52]Holland LM, Schröder MS, Turner SA, Comparative phenotypic analysis of the major fungal pathogens Candida parapsilosis and Candida albicans. PLoS Pathog 2014; 10: e1004365. 25233198 PMC4169492
- Authors
- Daneshnia, F., de Almeida Júnior, J. N., Ilkit, M., Lombardi, L., Perry, A. M., Gao, M., Nobile, C. J., Egger, M., Perlin, D. S., Zhai, B., Hohl, T. M., Gabaldón, T., Colombo, A. L., Hoenigl, M., & Arastehfar, A.
- Affiliations
- Massachusetts General Hospital (US)
- University College Dublin (IE)
- University of California, Merced (US)
- Medical University of Graz (AT)
- Hackensack Meridian Health (US)
- Chinese Academy of Sciences (CN)
- Memorial Sloan Kettering Cancer Center (US)
- Institució Catalana de Recerca i Estudis Avançats (ES)
- Universidade Federal de São Paulo (BR)
- Harvard University (US)
- Corresponding author
- Hoenigl, Martin
- Arastehfar, Amir
- ORCID
- Venue
- The Lancet Microbe
- Publisher
- Elsevier BV
- Published
- 2023-06
- Volume
- 4
- Issue
- 6
- Pages
- e470-e480
- ISSN
- 2666-5247 (ISSN-L)
- PMC
- PMC10634418
- OpenAlex
- W4367186743
- Cited by
- 257
- References
- 72
- Citations by year
- 2026: 73 · 2025: 91 · 2024: 72 · 2023: 19 · 2022: 1 · 2021: 1
- FWCI
- 12.06
- Type
- journal article
- Language
- en
- Update notices
- erratum (2023-08-01)
- Open access
- gold
- doi.org
- Licence
- Locations
- The Lancet Microbe (publishedVersion, cc-by)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- UPCommons institutional repository (Universitat Politècnica de Catalunya) (submittedVersion, cc-by-nc-nd)
- eScholarship (California Digital Library) (submittedVersion, cc-by)
- CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
- Funders
- National Institutes of Health (P30 CA008748, R01 AI139632, R21 AI156157, R35 GM124594, R37 AI093808)
- Horizon 2020
- Instituto de Salud Carlos III
- Fundación La Caixa
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Life Sciences › Agricultural and Biological Sciences › Ecology, Evolution, Behavior and Systematics › Fungal Plant Pathogen Control
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Yeasts and Rust Fungi Studies
- Keywords
- Candida parapsilosis, fluconazole resistance, candidemia, clonal outbreak, azole resistance, multidrug resistance, antifungal resistance, infection control, environmental reservoirs, pathogenesis
- MeSH terms
- Candida parapsilosis, Adult, Antifungal Agents, Azoles, Humans, Infant, Newborn, Microbial Sensitivity Tests, Fluconazole, Candidemia
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