Multidrug resistance mechanisms and therapeutic strategies in Candida auris

In recent years, Candida auris has emerged as a formidable global health threat due to its multidrug resistance, high transmissibility in healthcare settings, and diagnostic challenges. Unlike most Candida species, C. auris can colonize the skin, persist on surfaces, and resist common antifungal agents including azoles, echinocandins, and polyenes. Its rapid global spread and association with high mortality in immunocompromised patients have drawn intense clinical and scientific attention. This review aims to consolidate current knowledge on the mechanisms underlying antifungal resistance in C. auris, including genetic mutations in target enzymes (e.g., ERG11, FKS1), overexpression of efflux pumps, biofilm formation, and stress response pathways. Additionally, it explores the pathogen’s virulence factors, diagnostic challenges, and environmental resilience. We also provide a critical overview of emerging therapeutic strategies, including novel antifungal agents, combination therapies, and immunotherapeutic interventions. Special emphasis is given to the ongoing clinical trials and pipeline antifungals such as ibrexafungerp, manogepix, and rezafungin. The review concludes with future directions for research, highlighting the need for improved surveillance, molecular diagnostics, and antifungal stewardship to curb the rise of this deadly fungal pathogen.