Antimicrobial-Resistant Invasive Candidiasis

At a glance

  • Antimicrobial resistance happens when germs like bacteria and fungi develop the ability to defeat the drugs designed to kill them. That means the germs are not killed and continue to grow.
  • Antimicrobial-resistant invasive candidiasis is increasing.
  • Candidemia is the most common type of bloodstream infection in the U.S.
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Emerging resistance

Antimicrobial resistance is an increasing problem with the fungus Candida, a yeast. There are few antifungal medications currently available. Invasive candidiasis that is resistant to one or more antifungal can be difficult to treat.

Species and trends

About 7% of all Candida blood samples tested at CDC are resistant to the antifungal drug fluconazole. Although one Candida species, Candida albicans, is the most common cause of severe Candida infections, resistance is most common in other species, particularly Candida auris, Candida glabrata, and Candida parapsilosis.

Find information on Candida auris

Candida auris (C. auris), a species that recently emerged, is highly transmissible and different from other species of Candida. The majority of C. auris infections are resistant to at least one antifungal medication. Data on C. auris and resistance is collected and reported separately.

Echinocandin and azole resistance

Resistance to a class of antifungal drugs, echinocandins, is particularly concerning for treating invasive infections. Echinocandin resistance appears to be increasing, especially in the species Candida glabrata. C. glabrata already has high levels of resistance to the antifungal fluconazole, and this resistance has remained fairly constant over the past 20 years, according to CDC surveillance data.1Echinocandins are the preferred treatment for C. glabrata, and echinocandin resistance could severely limit treatment options for patients with candidiasis caused by C. glabrata.

Patients with Candida infections that are resistant to both fluconazole and echinocandin drugs have very few treatment options. The primary treatment option is amphotericin B, a drug that can be toxic for patients who are already very sick. Growing evidence suggests that patients who have antimicrobial-resistant Candida bloodstream infections (also known as candidemia) are less likely to survive than patients who have candidemia that can be treated by antifungal drugs.

  1. Toda M, Williams SR, Berkow EL, Farley MM, Harrison LH, Bonner L, et al. Population-based active surveillance for culture-confirmed candidemia — four sites, United States, 2012–2016. MMWR Surveill Summ 2019;68:1–15.