Global prevalence and trends of fluconazole resistance in non-albicans Candida species: a systematic review and meta-analysis
Abstract
BACKGROUND: The emergence of fluconazole-resistant non-albicans Candida (NAC) species poses a major challenge for the long-term management of candidiasis, particularly in immunocompromised patients. METHODS: A 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. RESULTS: This 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…
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