Longitudinal and Regional Trends in Antifungal Resistance Among Candida parapsilosis and Candida glabrata: A 14-Year Analysis of the SENTRY Antimicrobial Surveillance Program, 2010–2023 Open Access
Stauffer, Maxwell (Spring 2026)
Abstract
Background: Fluconazole resistance has increased among C. parapsilosis in recent years, and C. glabrata has intrinsic reduced azole susceptibility and capacity for echinocandin resistance. Pfaller et al. (2019), no subsequent SENTRY publication has characterized global and regional resistance proportions across a decade of surveillance through 2023. The present study extends the surveillance window by reporting descriptive resistance trends for both species globally and regionally, and by applying formal statistical methods established in the broader antimicrobial resistance surveillance literature to evaluate regional differences and temporal trends.
Methods: Invasive Isolates of C. parapsilosis (n = 2,352) and C. glabrata (n = 2,925) collected through the SENTRY Antifungal Surveillance Program from 2010 to 2023 were analyzed. CLSI M27M44S breakpoints for fluconazole, anidulafungin, micafungin, and caspofungin were applied retrospectively. Annual resistance proportions were computed for each drug-species combination by region and globally. Regional resistance differences and period comparisons between 2010-2016 and 2017-2023 were evaluated using Pearson chi-squared tests. Cochran-Armitage trend tests were applied as an exploratory framework to pre-specified strata, defined by six drug-species combinations and four geographic regions.
Results: Fluconazole resistance in C. parapsilosis increased over the study period, from 3.9% in 2010-2016 to 12.0% in 2017-2023 globally, particularly in Europe and North America (both p < 0.05 by temporal trend analysis); Europe recorded the highest pooled resistance across the full period at 13.1%. Echinocandin resistance in C. parapsilosis was negligible. Fluconazole resistance in C. glabrata declined from 8.4% to 5.5% between periods globally (p = 0.001), with decreasing trends concentrated in North America and Asia-Pacific. Echinocandin resistance in C. glabrata remained low and stable. Pooled resistance proportions differed significantly across regions for fluconazole in both species and for both echinocandins in C. glabrata (all p < 0.001).
Discussion: Fluconazole resistance in C. parapsilosis increased across the study period, particularly in Europe and North America, while echinocandin susceptibility was stable throughout. Fluconazole resistance in C. glabrata declined modestly, and echinocandin resistance remained stable at low levels. The divergent resistance trajectories of these two species underscore the importance of region-specific and species-specific monitoring in guiding antifungal stewardship.
Table of Contents
Table of Contents
I. Introduction .............................................................................................................................................1
II. Methods...................................................................................................................................................10
III. Results ...................................................................................................................................................17
IV. Limitations ............................................................................................................................................29
V. Discussion ..............................................................................................................................................34
VI. Conclusion ............................................................................................................................................41
VII. References............................................................................................................................................43
VIII. Figures & Supplementary Tables .......................................................................................................48
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Longitudinal and Regional Trends in Antifungal Resistance Among Candida parapsilosis and Candida glabrata: A 14-Year Analysis of the SENTRY Antimicrobial Surveillance Program, 2010–2023 () | 2026-04-23 15:19:31 -0400 |
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