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Antifungal Resistance in Clinical Fungi
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Antifungal Resistance in Clinical Fungi

A Special Issue of Journal of Fungi (ISSN 2309-608X) belonging to the section "Fungal Pathogenesis and Disease Control".

Deadline for manuscript submissions: 28 February 2027 | Viewed by 1356

Editor

Dr. Andres Ceballos-Garzon

E-Mail Website
Guest Editor
Translational Microbiology and Emerging Diseases Research Group (MICROS), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
Interests: medical mycology; antifungal susceptibility testing; antifungal resistance

Special Issue Information

Dear Colleagues,

Invasive fungal diseases (IFDs) affect more than 6.5 million people annually and have alarmingly high mortality rates. Although this burden alone demands urgent attention, the additional and rapidly growing threat of antifungal resistance (AFR) remains critically underappreciated within existing antimicrobial resistance frameworks, despite the fact that resistant infections are associated with worse clinical outcomes, including prolonged illness, treatment failure, and death.

AFR is accelerating across diverse pathogens, driven by selective pressure and a limited antifungal arsenal. We currently rely on three main antifungal classes (azoles, polyenes, and echinocandins), and resistance severely constrains therapeutic options. Azole-resistant Aspergillus fumigatus is associated with treatment failure and increased mortality. Echinocandin resistance in Candida glabrata, Candida tropicalis, and Candidozyma auris progressively undermines the clinical utility of this last-line antifungal class. Multidrug-resistant C. auris continues to cause global outbreaks. Trichophyton indotineae, Candida parapsilosis, and Sporothrix brasiliensis have all seen a growing number of reports of resistant isolates worldwide, with particular impact in low- and middle-income countries. Beyond acquired resistance, intrinsic resistance in Fusarium, Mucorales, Scedosporium, and Cryptococcus species further limits treatment, while heteroresistance enables initially susceptible isolates to adapt and eventually become resistant. Compounding this crisis are the lack of rapid non-culture-based diagnostics, the overuse of broad-spectrum antibacterials, widespread antifungal prophylaxis in high-risk populations, and environmental exposure to agricultural fungicides. For all these reasons, the study and understanding of resistant strains, as well as the development of new detection methods, are urgently needed.

Dr. Andres Ceballos-Garzon
Guest Editor

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Keywords

  • antifungal resistance
  • emerging fungal pathogens
  • antifungal stewardship
  • AFST

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Published Papers (4 papers)

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Research

13 pages, 492 KB  
Article
Ten-Year Voriconazole Susceptibility Trends Among 1482 Clinical Aspergillus fumigatus Isolates: A Compositionally Controlled Multicenter Analysis of the VIVLI/SENTRY Platform (2010–2020)
by Jose W. Lopez, Alicia A. Segura-Grados, Emily Olascoaga-Mori and Harold J. Rodríguez-Madueño
J. Fungi 2026, 12(9), 699; https://doi.org/10.3390/jof12090699 (registering DOI) - 18 Sep 2026
Viewed by 47
Abstract
Azole resistance in Aspergillus fumigatus is an emerging threat to invasive and chronic aspergillosis management, yet multicenter trend analyses rarely verify whether the composition of surveillance data remained stable over time. We performed a longitudinal, secondary-data analysis of 2111 Aspergillus isolates registered in [...] Read more.
Azole resistance in Aspergillus fumigatus is an emerging threat to invasive and chronic aspergillosis management, yet multicenter trend analyses rarely verify whether the composition of surveillance data remained stable over time. We performed a longitudinal, secondary-data analysis of 2111 Aspergillus isolates registered in the VIVLI AMR platform (ATLAS Antifungals, SENTRY Program) between 2010 and 2020. Because Clinical and Laboratory Standards Institute (CLSI) voriconazole breakpoints are established only for A. fumigatus in this dataset, the susceptibility-trend analysis was restricted to A. fumigatus isolates with a valid interpretation (n = 1482/1483). A. fumigatus accounted for 70.3% of all Aspergillus isolates; most originated from Europe (43.9%) and North America (35.2%). Region and clinical specialty differed significantly across the three study periods (both p < 0.0001), while species, age, sex and specimen-source distributions remained stable (p > 0.10). Voriconazole susceptibility in A. fumigatus declined from 97.9% (2010) to 90.4% (2020), with a significant linear downward trend (Cochran–Armitage Z = −3.03, p = 0.002). This decline was statistically robust, but the concurrent shift in participating regions and specialties indicates that compositional changes in surveillance sampling should be considered alongside biological resistance emergence when interpreting multicenter antifungal surveillance trends. Full article
(This article belongs to the Special Issue Antifungal Resistance in Clinical Fungi)
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11 pages, 516 KB  
Article
First Isolation of Candida parapsilosis from Water-Related Domestic Environments in Colombia: A Public Health Concern?
by Norida Vélez, Valentina Valencia, Yohana M. Velasco-Santamaría, Patricia Escandón, María José Jiménez-A and Andrés Ceballos-Garzon
J. Fungi 2026, 12(9), 694; https://doi.org/10.3390/jof12090694 - 16 Sep 2026
Viewed by 200
Abstract
Background: Candida parapsilosis is an opportunistic yeast of increasing clinical importance, with fluconazole resistance rates rising globally and reaching concerning levels in clinical settings across several countries, including Colombia. However, the occurrence of antifungal-resistant Candida species in domestic water systems in the country [...] Read more.
Background: Candida parapsilosis is an opportunistic yeast of increasing clinical importance, with fluconazole resistance rates rising globally and reaching concerning levels in clinical settings across several countries, including Colombia. However, the occurrence of antifungal-resistant Candida species in domestic water systems in the country remains largely unexplored. Methods: This cross-sectional study assessed the occurrence and antifungal susceptibility of Candida spp. in intradomiciliary water from 104 households in Villavicencio, Colombia, during two monitoring periods. Water samples were filtered, and yeast-like colonies were identified using MALDI-TOF mass spectrometry. Susceptibility to fluconazole, amphotericin B, and anidulafungin was determined using the CLSI broth microdilution method. The ERG11 gene was sequenced in the fluconazole-resistant isolate. Results: C. parapsilosis was recovered from 16 of 104 households (15.4%), yielding 22 isolates distributed across six communes. Most isolates (72.7%) were obtained from household water storage tanks. One isolate was resistant to fluconazole (MIC = 8 µg/mL) and harbored a nonsynonymous R398I substitution in ERG11. Conclusions: To our knowledge, this is the first report of C. parapsilosis, including a fluconazole-resistant isolate carrying an ERG11 substitution, recovered from domestic water in Colombia. These findings suggest that household water storage tanks may serve as environmental reservoirs for this opportunistic yeast. The implications for human exposure remain to be determined and highlight the need for integrated One Health surveillance. Full article
(This article belongs to the Special Issue Antifungal Resistance in Clinical Fungi)
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11 pages, 404 KB  
Article
Epidemiological Characteristics of Clinical Aspergillus Section Nigri and Mutations in cyp51A Gene
by Yuyi Zhang, Yao Zhang, Suzhen Wang, Chunmei Zhou, Jue Pan, Wei Guo and Bijie Hu
J. Fungi 2026, 12(9), 683; https://doi.org/10.3390/jof12090683 - 11 Sep 2026
Viewed by 391
Abstract
Aspergillus section Nigri is distributed ubiquitously in nature and is reported to be the third most clinically significant species of the Aspergillus genus. In this study, we surveyed Aspergillus section Nigri isolates from Zhongshan Hospital, Fudan University, Shanghai, China, from 2019 to 2023. [...] Read more.
Aspergillus section Nigri is distributed ubiquitously in nature and is reported to be the third most clinically significant species of the Aspergillus genus. In this study, we surveyed Aspergillus section Nigri isolates from Zhongshan Hospital, Fudan University, Shanghai, China, from 2019 to 2023. We determined the species distribution of section Nigri isolates by partial β-tubulin gene sequencing. We characterized the antifungal susceptibility profiles of these isolates to medical azoles (itraconazole, voriconazole, posaconazole, and isavuconazole) using the SensititreTM custom-designed broth microdilution system. The cyp51A sequences were compared between azole-resistant and azole-susceptible strains in order to determine the potential antifungal resistance mechanism. A total of 54 Aspergillus section Nigri isolates were obtained. A. tubingensis (50.0%) and A. niger (46.3%) were the most prevalent species. Two isolates of A. welwitschiae were identified. Resistance to Itraconazole, voriconazole, and isavuconazole was found in 26%, 33.3%, and 33.3% of A. tubingensis isolates, respectively. All A. niger and A. welwitschiae isolates were sensitive to these azoles. Three amino acid mutations were found in azole-resistant A. tubingensis isolates, namely Y119F, Y119H, and T321A. Results from this study provide us with an understanding of species distribution and antifungal susceptibility profiles of clinical Aspergillus section Nigri isolates in Eastern China. It highlights the importance of accurate species identification and antifungal susceptibility testing. Our results also suggest that the novel Y119F substitution is potentially a key player in azole resistance. Full article
(This article belongs to the Special Issue Antifungal Resistance in Clinical Fungi)
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15 pages, 2488 KB  
Article
Candidemia in Colombia: Species Distribution and Antifungal Susceptibility Profiles of Yeast Bloodstream Isolates from a Six-Year Multicentre Surveillance Study
by Andres Ceballos-Garzon, Nicolas Beltran, Valeri Saenz, Luz-Angela Pescador, Diego Josa, Alejandro Rodriguez-Bobadilla, Luisa-Fernanda Rodriguez, Rosalba Quintero-Munoz, Ivan-Felipe Gutierrez, Maria del Pilar Torres-Navarrete, Liliana Arevalo, Diana P. Cely-Ladino, Gloria Cortes, Luisa F. Ortiz-Torres, Rafael Pelufo, Nella Sanchez, Leidy Bogota, Claudia R. Sierra-Parada, Laura-Daniela Méndez, Maria J. Jimenez-A, Lizeth Paola Gutierrez, Jorge-Alberto Cortes and Aura-Lucia Lealadd Show full author list remove Hide full author list
J. Fungi 2026, 12(9), 640; https://doi.org/10.3390/jof12090640 - 27 Aug 2026
Cited by 1 | Viewed by 499
Abstract
A multicentre, laboratory-based analysis was conducted on aggregated data from 23 hospitals across Colombia. Of 1761 fungal isolates identified, 1642 were yeasts and constitute the focus of this study. Isolates were identified using the VITEK®2 system, with confirmatory identification by MALDI-TOF-MS [...] Read more.
A multicentre, laboratory-based analysis was conducted on aggregated data from 23 hospitals across Colombia. Of 1761 fungal isolates identified, 1642 were yeasts and constitute the focus of this study. Isolates were identified using the VITEK®2 system, with confirmatory identification by MALDI-TOF-MS for a subset. Antifungal susceptibility testing for fluconazole, voriconazole, amphotericin B, and the echinocandins was performed on Candida albicans, C. parapsilosis, and C. tropicalis. Data were stratified by clinical service: adult ICU, adult wards, paediatric ICU, neonatal ICU, and paediatric wards. Temporal trends were assessed using the Cochran–Armitage test. The most prevalent species were C. albicans (42%), C. parapsilosis (24%), C. tropicalis (11%), C. glabrata (7%), and C. auris (3%). C. albicans predominated in adult services, whereas C. parapsilosis was the leading pathogen across paediatric settings. Among species with validated breakpoints, the overall fluconazole resistance rate was 19%, driven primarily by C. parapsilosis (35%, exceeding 40% in some clinical services). Non-wild-type to voriconazole and amphotericin B was low (<5%), and echinocandin resistance was exceedingly rare. The substantial fluconazole resistance driven by C. parapsilosis, together with the emergence of C. auris, underscores the urgent need for sustained surveillance and species-directed antifungal stewardship programmes. Full article
(This article belongs to the Special Issue Antifungal Resistance in Clinical Fungi)
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