Mechanisms and species-specific patterns of ECM-mediated antifungal resistance in <i>Candida</i> biofilms: a systematic review and exploratory quantitative synthesis

AIMS: biofilms contribute to antifungal resistance across species and antifungal drug classes. MATERIALS AND METHODS: biofilms. Qualitative synthesis mapped ECM components and pathways, while harmonizable semi-quantitative data were summarized as directional modeled estimates. RESULTS: , more often combined ECM protection with efflux-linked resistance. CONCLUSIONS: biofilms is multilayered, species-dependent and drug-class specific. These findings support species-aware interpretation of biofilm-associated antifungal resistance and further development of ECM-directed adjunctive strategies.