Global surveillance of Candida albicans : MIC distributions, resistance patterns, and temporal trends from the Antimicrobial Testing Leadership and Surveillance program (2015–2024)

ABSTRACT Candida albicans remains the predominant cause of invasive candidiasis worldwide, yet comprehensive global analyses of its antifungal susceptibility trends remain scarce. In this decade-long study, we evaluated 6,342 C. albicans isolates collected between 2015 and 2024 through the Antimicrobial Testing Leadership and Surveillance global surveillance program, representing 41 countries across four continents. Europe accounted for more than half of all isolates, followed by North America, Asia–Western Pacific, and Latin America. The majority of isolates were derived from elderly and critically ill patients, particularly those hospitalized in internal medicine or intensive care units. Echinocandins and amphotericin B demonstrated sustained potency, maintaining low minimum inhibitory concentration (MIC) 50 /MIC 90 values (0.015−0.03 mg/L and 0.5/1 mg/L, respectively) and ≥99% susceptibility throughout the surveillance period. In contrast, fluconazole and voriconazole exhibited broader MIC distributions and a subtle upward shift in MIC 90 after 2022. Although global resistance rates remained below 1%, small numbers of resistant isolates were detected in several countries, including Greece (2.1%, n = 1), Belgium (1.1%, n = 4), Ireland (0.7%, n = 2), Turkey (0.5%, n = 2) and the United States (0.3%, n = 10). Temporal analysis further revealed a gradual increase in azole non–wild-type isolates from 2019 to 2024, while echinocandin susceptibility remained stable. These findings confirm that C. albicans remains broadly susceptible to frontline antifungal agents, yet the observed low-magnitude shifts and localized increases underscore the value of continued standardized surveillance and cautious, region-informed stewardship.