Centers for Disease Control and Prevention

Antimicrobial Resistance Threats Report

Drug-resistantCandida

Threat Level: SERIOUS

In the United States in 2023:

CDC changed methodologies and data sources to produce the most comprehensive AR Threats Report to date. Direct comparison of this threat's data to previous reports is not recommended.

What you need to know

Candida are a yeast (a type of fungus) that live on the skin and in parts of the body and normally do not cause an infection. However, Candida can overgrow and cause infections that can range from mild oral and vaginal yeast infections to invasive, life-threatening infections. Invasive infections happen when Candida spread to parts of the body that are normally sterile (free from germs), such as blood, cerebrospinal fluid, internal organs such as the kidney or brain, or internal body sites like bone.

Severe, invasive Candida infections typically affect hospitalized patients, particularly those with invasive medical devices like central venous catheters and people with underlying health conditions. Generally, healthy people without severe illnesses are considered at very low risk for invasive Candida infections.

Some strains of Candida are resistant to common antifungal treatments. Infections caused by drug-resistant Candida can be harder to treat.

Drug-resistant Candida data

In the United States, the estimated number of hospitalized drug-resistant Candida cases reached nearly 33,600 in 2023, the highest estimate during 2019 to 2023.

Estimated number of hospitalized drug-resistant Candida cases and deaths by year in the U.S.

From 2019 to 2023, estimates for hospitalized drug-resistant Candida cases and deaths attributable to drug-resistant Candida increased. The credible intervals (range of values likely to include the true value) for the yearly estimates overlap during 2019 to 2023, suggesting that assessment of changes from year to year should be made cautiously.

As the estimated number of hospitalized drug-resistant cases increased, along with the subset of bloodstream drug-resistant cases, so did the estimated percentage of Candida bloodstream isolates (pure samples of Candida) that were drug-resistant.

Percent of drug-resistant Candida bloodstream isolates by year in the U.S.

The estimated percentage of Candida bloodstream isolates that were resistant to certain antifungals (including fluconazole, voriconazole, anidulafungin, caspofungin, micafungin, or amphotericin B) generally increased from 2019 to 2023. The credible intervals for the yearly estimates overlap during this period, suggesting that assessment of changes from year to year should be made cautiously. Potential increases in the number of drug-resistant cases and percentage of resistant isolates could be due to multiple factors, including increasing resistance in Candida species and a larger share of infections caused by species that are more likely to be drug-resistant or spread in healthcare settings. When resistance increases, it is concerning as there are few antifungal treatments available for patients with these infections. This makes preventing infections even more critical.

The rising threat of drug-resistant Candida in Atlanta

Gloved hands holding a clear agar test plate showing a white culture of yeast (fungus).

Monitoring and laboratory testing are critical to identify emerging resistance patterns, detect spread, improve treatment practices, and to help guide implementation of effective infection prevention and control strategies.

In 2021, the Georgia Emerging Infections Program (EIP) and CDC noticed a concerning rise in infections caused by a resistant type of fungus, fluconazole-resistant Candida parapsilosis (C. parapsilosis). This rise in resistance was concerning because fluconazole is one of the few antifungal drugs available to treat Candida infections, leaving these infections difficult to treat.
Through careful monitoring and testing of patient samples, CDC and its partners found that the percentage of fluconazole-resistant strains doubled from 17% in 2020 to 34% in 2021 across the Atlanta metropolitan area. Notably, many patients with fluconazole-resistant C. parapsilosis had not recently taken fluconazole, and genetic testing revealed that the resistant strains were genetically similar, suggesting that resistance was spreading between patients rather than developing in individual patients as a result of fluconazole use.
Ongoing monitoring and laboratory testing is critical to identify and understand emerging patterns of drug resistance and detect spread. Healthcare providers should use laboratory testing, including pathogen identification, antifungal susceptibility testing, and genetic testing of Candida specimens to improve treatment practices and to help guide public health officials to implement effective infection prevention and control strategies.

How CDC combats drug-resistant Candida

  • Tracking Candida bloodstream infections through population-based surveillance

    Through the Emerging Infections Program, CDC monitors trends in Candida bloodstream infections, associated risk factors, and drug resistance at 10 U.S. sites representing approximately 21.5 million people. Each year, CDC collects data and performs antifungal susceptibility testing on about 1,500 Candida bloodstream isolates (pure samples of Candida). This surveillance helps clinicians and public health officials identify emerging resistance patterns and guide prevention and treatment strategies.

  • Strengthening laboratory detection

    CDC's Antimicrobial Resistance Laboratory Network supports state public health laboratories in identifying Candida species and performing antifungal susceptibility testing. As of 2025, the network has tested more than 70,000 Candida isolates and performed susceptibility testing on over 45,000. Identification and testing improve timely diagnosis and help ensure patients receive appropriate treatment.

  • Investigating and controlling outbreaks

    CDC supports health departments in detecting and responding to outbreaks of drug-resistant Candida in healthcare settings. Tools such as whole genome sequencing allow public health officials to compare the genetic relatedness of strains, determine whether infections are spreading between patients, and identify sources of transmission. These findings guide targeted infection prevention and control measures to stop further spread.

  • Building prevention and response capacity nationwide

    CDC strengthens U.S. capacity by providing training, technical assistance, and guidance to healthcare facilities and public health partners. This includes education on infection prevention practices, appropriate antifungal use, laboratory testing strategies, and outbreak response. By equipping healthcare professionals and health departments with these tools, CDC helps prevent the spread of drug-resistant Candida and improve patient outcomes.

Drug-resistant Candida resources

Illustration of Drug-resistant Candida