SynthesisBMC infectious diseases2026
Global prevalence and trends of fluconazole resistance in non-albicans Candida species: a systematic review and meta-analysis.
Synthesis in BMC infectious diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Sensing the host atmosphere: carbon dioxide regulates virulence and drug response in medically relevant fungi.Medical gas research · 2026Review
- Bridging the "Valley of Death" in Antifungal Therapy: Next-Generation Biomimetic and Exosome-Inspired Nanocarriers for Invasive Candidiasis.Journal of fungi (Basel, Switzerland) · 2026Review
- Virulence determinants, antifungal resistance, and genotype-phenotype associations in Candida bloodstream isolates: a three-year surveillance study from Northern India.Scientific reports · 2026Article
- Impact of COVID-19 and earthquake disaster on candidemia in the ICU: mortality and treatment outcomes.BMC infectious diseases · 2026Article
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe emergence of fluconazole-resistant non-albicans Candida (NAC) species poses a major challenge for the long-term management of candidiasis, particularly in immunocompromised patients.
methodsA systematic search of four major databases was performed in accordance with the PRISMA 2020 guidelines to identify studies reporting fluconazole resistance among NAC species. Data were pooled using a random-effects model to estimate resistance prevalence with 95% confidence intervals (CIs). Heterogeneity was assessed using Cochran’s Q test and the I² statistic.
resultsThis global meta-analysis evaluated the prevalence of fluconazole resistance among NAC species. Resistance rates varied substantially across species, with C. krusei showing the highest pooled resistance (78.3%), followed by C. glabrata (15.9%), C. tropicalis (13.0%), and C. dubliniensis (11.1%). Subgroup analyses revealed increasing temporal trends in resistance, particularly for C. krusei, C. parapsilosis, and C. tropicalis, with statistically significant increases confirmed by meta-regression (p < 0.05). Geographic disparities were evident: C. glabrata resistance was highest in South Korea (80.5%) and lowest in Peru (1.3%), while C. krusei resistance peaked in the Americas (96.7%) and was lowest in Africa (34.1%). Resistance estimates also differed by antifungal susceptibility testing (AST) method, particularly for C. krusei, where MIC-based methods identified substantially higher resistance than other approaches. Evidence of publication bias was detected for C. glabrata, C. krusei, and C. dubliniensis, suggesting possible overestimation of resistance rates.
conclusionFluconazole resistance among NAC species is rising globally, with particularly notable increases in C. krusei, C. glabrata, C. tropicalis, and C. dubliniensis. Significant geographic and methodological variations underscore the need for region-specific antifungal stewardship and standardized susceptibility testing. Addressing publication bias, strengthening surveillance systems, and developing alternative antifungal therapies are critical for the effective management of invasive candidiasis. CLINICAL TRIAL NUMBER: Not applicable.
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