Combined antifungal resistance and biofilm tolerance: the global threat of Candida auris

The enigmatic yeast Candida auris has emerged over the last decade and rapidly penetrated into our consciousness. The global threat from this multidrug resistant yeast has generated a call to arms from within the medical mycology community. Over the past decade our understanding of how this yeast has spread globally, its clinical importance, and how it tolerates and resists antifungal agents has expanded. This review highlights the clinical importance of antifungal resistance in C. auris and explores our current understanding of the mechanisms associated with azole, polyene and echinocandin resistance. We also discuss the impact of phenotypic tolerance, with particular emphasis on biofilm mediated resistance, and present new pipelines of antifungal drugs that promise new hope in the management of C. auris infection