Promising Drug Candidates and Emerging Therapeutic Strategies Against Candida auris
Emerging therapies for Candida auris extend beyond conventional antifungal agents and include repurposed drugs, novel antifungal compounds, vaccines, antimicrobial peptides, and nanotechnology-based approaches. While further clinical validation is needed, these strategies may help address the growing challenge of multidrug-resistant C. auris infections.
KEY FINDINGS: This review underscores the expanding pipeline of therapeutic strategies targeting Candida auris, ranging from repurposed medications and next-generation antifungal agents to vaccines, antimicrobial peptides, nanoparticle formulations, and innovative environmental control measures. Although no single therapy has emerged as a definitive solution, compounds such as ibrexafungerp (SCY-078), ATI-2307, and fosmanogepix, together with drug repurposing and bioinspired approaches, represent promising avenues for addressing multidrug-resistant C. auris infections. Continued translational research and clinical evaluation remain essential to establish safe and effective treatment options for this increasingly important fungal pathogen.
BACKGROUND: Candida auris has rapidly emerged as a multidrug-resistant fungal pathogen of global concern since its first identification in 2009. The organism is associated with healthcare-associated outbreaks, high transmissibility, frequent misidentification, and severe invasive infections, with reported mortality rates ranging from 35% to 72%. Resistance to currently available antifungal agents further complicates treatment, with approximately 90% of isolates resistant to fluconazole, around 30% resistant to amphotericin B, and fewer than 5% resistant to echinocandins. These challenges have accelerated efforts to identify novel antifungal therapies and alternative treatment strategies.
DETAILS: This publication is a comprehensive narrative review that summarizes advances in antifungal research targeting C. auris over the preceding decade. The authors evaluated emerging therapeutic approaches from a medicinal chemistry perspective, including drug repurposing, combination therapy, novel antifungal agents, natural products, metal-based compounds, nanoparticles, vaccines, antimicrobial peptides, and environmental decontamination strategies. The review also examined chemical and physicochemical characteristics of promising compounds, including lipophilicity and topological polar surface area, to identify structural features that may facilitate future antifungal drug development. The review highlights several promising therapeutic candidates with activity against multidrug-resistant C. auris. Drug repurposing identified multiple agents with antifungal or antibiofilm activity, including sertraline, miltefosine, iodoquinol, octenidine dihydrochloride, taurolidine, and bensulfuron methyl. Miltefosine demonstrated fungicidal and antibiofilm activity, while encapsulation within alginate nanoparticles reduced toxicity and improved survival in an infected Galleria mellonella model. The NDV-3A vaccine generated cross-reactive antibodies against C. auris and protected neutropenic mice, with additive efficacy when combined with micafungin.
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Among novel antifungal agents, SCY-078 (ibrexafungerp), an orally available 1,3-ß-D-glucan synthesis inhibitor, demonstrated potent activity against C. auris, with an MIC90 of 1 mg/L and MIC50 and MIC90 values of 0.5 µg/mL and 1 µg/mL, respectively, across 100 isolates representing the four major clades. More than 150 strains with diverse resistance profiles were subsequently shown to be uniformly susceptible to SCY-078, and the agent remained active against pan-resistant isolates while also exhibiting antibiofilm activity.
Additional investigational therapies also demonstrated encouraging preclinical activity. The arylamidine T-2307 (ATI-2307) exhibited in vitro MIC values ranging from 0.125 to 4 µg/mL and improved survival while reducing kidney fungal burden in murine infection models following 3 mg/kg once-daily subcutaneous treatment. Other experimental approaches included antimicrobial peptides, ceragenins, fluorinated hydrazone derivatives, and novel chemical scaffolds designed to overcome existing resistance mechanisms.
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Source: Billamboz, M., Fatima, Z., Hameed, S., et al. Promising Drug Candidates and New Strategies for Fighting against the Emerging Superbug Candida auris. Microorganisms. 2021; 9(3): 634. Published: March 18, 2021. DOI: 10.3390/microorganisms9030634.
Increased Use of Adjunctive Azithromycin After Unscheduled Cesarean Delivery Associated With Lower Postpartum Infection Rates Background
A US analysis of 1.66 million deliveries found that adjunctive azithromycin use during cesarean delivery increased from 2.2% before 2016 to 39.6% during 2017–2024. Over the same period, postpartum infection after cesarean delivery declined from 9.2% to 8.0%. The findings suggest that evidence from the 2016 clinical trial was followed by substantial adoption in routine practice and lower postpartum infection rates.
KEY FINDINGS: In this large US observational analysis, publication of randomized trial evidence in 2016 was followed by a substantial increase in adjunctive azithromycin use during unscheduled cesarean delivery and a relative reduction in postpartum infections. The study provides evidence that clinical trial findings were subsequently incorporated into routine practice beyond the original trial setting. Because this was an observational difference-in-differences analysis rather than a new randomized trial, the findings demonstrate an association between adoption of the intervention and changes in infection rates rather than establishing causality.
BACKGROUND: Unscheduled cesarean delivery is associated with a higher risk of postpartum infection. A 2016 clinical trial showed that adding azithromycin to standard antibiotic prophylaxis could reduce postoperative infections in patients undergoing unscheduled cesarean delivery. This study evaluated whether use of adjunctive azithromycin increased after publication of that trial and whether postpartum infection rates subsequently changed in routine US practice.
DETAILS: Investigators conducted a difference-in-differences analysis using Epic Cosmos data from 2013 through 2024. The analysis included pregnant individuals who received prenatal care, experienced labor, and delivered a live singleton infant at 24 to 43 weeks' gestation. Cesarean deliveries served as the treatment group and vaginal deliveries as the comparison group, allowing changes occurring after publication of the 2016 trial to be assessed relative to trends in vaginal births.
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The study included 1,663,441 deliveries, comprising 202,234 cesarean births and 1,461,207 vaginal births. The primary outcomes were perioperative azithromycin administration and postpartum infection occurring within 6 weeks of delivery. The investigators compared births from January 1, 2013, through September 28, 2016, with those occurring from January 1, 2017, through December 31, 2024.
Before publication of the 2016 trial, azithromycin was administered during 2.2% of cesarean births compared with 0.01% of vaginal births. During 2017-2024, use increased to 39.6% of cesarean births and 0.04% of vaginal births. The adjusted difference-in-differences estimate for cesarean births was 37.6 percentage points (95% CI, 33.1 to 42.2). Postpartum infection after cesarean delivery declined from 9.2% during the pre-2016 period to 8.0% during 2017-2024. Among vaginal births, infection rates changed from 2.0% to 2.7%, producing an adjusted difference-in-differences estimate of -2.0 percentage points (95% CI, -2.6 to -1.4) for cesarean births. The findings therefore showed that, following publication of the randomized trial, adjunctive azithromycin use increased substantially among patients undergoing unscheduled cesarean delivery while postpartum infection rates decreased relative to the comparison group.
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Source: Freret, T. S., Litman, E., Wen, T., et al. Adoption of Adjunctive Azithromycin for Unscheduled Cesarean Delivery and Postpartum Infections. JAMA. 2026; Published: September 14, 2026. DOI: 10.1001/jama.2026.15010.
Accounting for Long-Term Consequences of Tuberculosis Strengthens the Case for Preventive Screening in New Immigrants
A Canadian modeling study found that including long-term illness and mortality after tuberculosis more than doubled the estimated health benefits of postarrival TB screening and preventive treatment among new immigrants. Incorporating these consequences reduced the projected cost from $235,088 to $100,742 CAD per QALY gained. The findings highlight the importance of considering the long-term burden of TB when evaluating prevention strategies.
KEY FINDINGS: The analysis suggests that excluding long-term illness, mortality, and healthcare costs after TB treatment can substantially underestimate the health value of TB prevention. In the modeled Canadian immigrant population, incorporating these consequences more than doubled the estimated QALY benefit of postarrival TB infection screening and preventive treatment and reduced the estimated cost per QALY by more than half. However, the findings depend on assumptions about the long-term effects of TB, and the investigators noted that some underlying associations may include residual confounding and that post-TB illness estimates are less certain.
BACKGROUND: Tuberculosis prevention strategies are commonly evaluated by considering acute TB disease and death, while longer-term consequences after successful treatment may be overlooked. These consequences can include persistent illness, increased mortality, and additional healthcare utilization. This study assessed how incorporating these longer-term effects would change estimates of the health benefits and cost-effectiveness of postarrival TB infection screening and preventive treatment among people newly immigrating to Canada.
DETAILS: The investigators developed a Markov microsimulation model representing a hypothetical cohort of 400,000 people immigrating permanently to Canada in 2025. The analysis compared the existing postarrival TB infection screening level of 0.5% with a modeled screening strategy reaching 68% of eligible new immigrants. The intervention targeted new permanent residents from countries with annual TB incidence >50/100,000 persons; individuals testing positive for TB infection were assumed to receive 4 months of daily rifampin as preventive treatment. Outcomes were projected over 25 years and included TB episodes, TB deaths, quality-adjusted life-years (QALYs), and TB-related healthcare costs. The model incorporated three post-TB consequences: increased mortality after TB treatment, persistent illness or disability, and excess healthcare costs. A total of 2,000 probabilistic simulations were performed to account for uncertainty in model parameters.
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When only acute TB consequences were considered under the current screening scenario, the model projected 927 (95% UR 764-1,123) TB cases, 30 (95% UR 24-36) TB deaths, and 312 (95% UR 241-386) QALYs lost over 25 years. Adding post-TB death increased estimated QALYs lost by 1.6-fold, while including post-TB illness increased them by 1.5-fold. When all three long-term consequences were incorporated, TB was projected to account for 657 (95% UR 479-876) QALYs lost, a 2.1-fold increase compared with considering acute consequences alone.
The expanded screening and preventive-treatment strategy produced 2.4-fold greater estimated QALY gains (95% UR 1.6-4.4-fold) and 2.2-fold more TB deaths averted (95% UR 1.6-3.0-fold) when all post-TB consequences were included. The estimated incremental cost-effectiveness ratio decreased from $235,088 to $100,742 CAD per QALY gained. In the model incorporating all post-TB consequences, 53% of simulations fell below a willingness-to-pay threshold of $100,000 per QALY, compared with 8% when only acute TB consequences were considered.
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Source: Ainiwaer, A., Uppal, A., Schwartzman, K., et al. Posttuberculosis Consequences on Tuberculosis Prevention Effectiveness and Cost-effectiveness among New Immigrants, Canada. Emerging Infectious Diseases. 2026; 32(9): 1421-1429. Published: September, 2026. DOI: 10.3201/eid3209.260473.
Broad-Spectrum Antibiotic Use Is Lower Among Hospice Patients With Cancer at the End of Life
In this nationwide Korean cohort, hospice utilization was associated with lower broad-spectrum antibiotic use as death approached, particularly during the final week and final 3 days of life. The findings suggest that hospice involvement may be associated with a transition toward more selective antimicrobial use and less intensive treatment near the end of life. However, the study was observational, and causality cannot be established. Important clinical variables, including infection severity, microbiological findings, functional status, symptom burden, cancer stage, and treatment intent, were unavailable in the claims data.
KEY FINDINGS: Among adults with cancer approaching death, hospice utilization was associated with less frequent and lower-intensity broad-spectrum antibiotic exposure, particularly during the final days of life. The findings are consistent with a transition toward comfort-focused care, although they do not establish that hospice care itself caused the reduction. Hospice initiation occurred relatively close to death, with a mean interval of 39.9 days and a median of 22.0 days, and some antibiotic treatment may have preceded hospice enrollment. In addition, cancer stage, treatment status, infection severity, microbiological findings, functional status, symptom burden, and treatment intent were unavailable in the claims data.
BACKGROUND: Antibiotic treatment remains common during end-of-life care for patients with cancer, despite uncertain benefits for survival and potential burdens including drug toxicity, intravenous administration, adverse effects, and antimicrobial resistance. This retrospective cohort study evaluated whether hospice involvement was associated with differences in broad-spectrum antibiotic use among adults with cancer during the final 3 months of life.
DETAILS: Investigators analyzed Korean National Health Insurance Service claims data for adults aged ≥18 years who died between January 1, 2018, and December 31, 2021, with one of the 10 leading cancer-related causes of death. Hospice users had received inpatient, home-based, or consultation-based hospice care before death. Broad-spectrum antibiotic exposure included anti-pseudomonal penicillins, anti-pseudomonal cephalosporins, carbapenems, and glycopeptides. The final 90 days of life were divided into four intervals: 1–3 months before death, 1 week to 1 month before death, the final week, and the final 3 days. Antibiotic exposure was assessed by the proportion of patients receiving antibiotics and by days of therapy (DOT) per 1,000 patient-days. Propensity score matching was performed at a 1:2 ratio.
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After matching, 38,102 hospice users and 75,736 non-hospice users were analyzed. During the final 3 months of life, 74.6% of hospice users and 79.0% of non-hospice users received at least one broad-spectrum antibiotic (P0.001). Antibiotic use was initially slightly higher among hospice users during the period 1–3 months before death, at 34.0% versus 32.2% (P0.001), but became consistently lower among hospice users thereafter. From 1 week to 1 month before death, use was 31.1% versus 32.8%; during the final week, 11.3% versus 18.5%; and during the final 3 days, 4.8% versus 10.3% among hospice and non-hospice users, respectively (all P0.001).
Days of therapy per 1,000 patient-days were also consistently lower among hospice users, with the greatest differences occurring during the final week and final 3 days of life. Carbapenems and glycopeptides demonstrated particularly pronounced differences between the groups. In cancer-specific analyses, patients with hematologic malignancies had the highest overall antibiotic exposure, followed by those with pancreatobiliary and gastric cancers, while exposure was comparatively lower among patients with breast and liver cancers.
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Source: Jeung, Y. S., Kim, H. J., Yu, J., et al. Comparison of Broad-Spectrum Antibiotic Use According to Hospice Utilization Among Patients with Cancer at the End of Life in South Korea: A Nationwide Analysis. Journal of Hospice and Palliative Care. 2026; 29(2): 41-50. Published: June 1, 2026. DOI: 10.14475/jhpc.2026.29.2.41.
US Measles Cases Rise in 2026 as Outbreaks Continue Amid Declining MMR Coverage
US measles activity has increased substantially in 2026, with 2,465 confirmed cases and 38 new outbreaks reported as of August 6. Declining MMR coverage may increase community vulnerability to transmission. Maintaining high vaccination coverage remains central to preventing measles outbreaks and sustaining elimination.
KEY FINDINGS: As of August 6, 2026, the US had reported 2,465 confirmed measles cases and 38 new outbreaks, with 94% of cases outbreak-associated. The increase occurs alongside a decline in kindergarten MMR coverage to 92.5% in 2024-2025 from 95.2% in 2019-2020. CDC emphasizes that measles can spread rapidly in communities with lower vaccination coverage, while 2 doses of MMR vaccine provide 97% protection against measles.
BACKGROUND: Measles was officially eliminated in the United States in 2000 following widespread use of the measles, mumps, and rubella (MMR) vaccine. However, declining vaccination coverage and increasing global measles activity have increased opportunities for measles transmission following importation into the United States.
DETAILS: As of August 6, 2026, the Centers for Disease Control and Prevention (CDC) reported 2,465 confirmed measles cases in the United States in 2026. Of these, 2,449 cases were reported by 47 jurisdictions, while 16 cases occurred among international visitors to the United States. Thirty-eight new outbreaks had been reported during 2026.
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Overall, 94% of confirmed cases in 2026 (2,309 of 2,465) were associated with outbreaks, including 936 cases from outbreaks beginning in 2026 and 1,373 from outbreaks that began in 2025. For comparison, 2,289 confirmed cases and 48 outbreaks were reported during the full year of 2025; 90% of cases (2,066 of 2,289) were outbreak-associated.
CDC reports confirmed measles cases notified by jurisdictions as of noon on Thursdays. An outbreak is defined as 3 or more related cases. State and CDC counts may differ because jurisdictions update and publicly report their data on different schedules.
MMR vaccination coverage among US kindergartners declined from 95.2% during the 2019-2020 school year to 92.5% during the 2024-2025 school year, leaving approximately 286,000 kindergartners at risk during the 2024-2025 school year. CDC notes that communities with vaccination coverage below the 95% level are more vulnerable to measles outbreaks. The 2026 measles case count reported by CDC as of August 6, 2026, had already exceeded the total number of confirmed cases reported during all of 2025 (2,465 vs 2,289). The high proportion of outbreak-associated cases indicates sustained transmission within affected communities.
The burden of measles remains closely associated with vaccination status. CDC reports that 2 doses of MMR vaccine are 97% effective at preventing measles, while 1 dose is 93% effective. Breakthrough infections can occur, particularly during outbreaks with high levels of circulating measles virus, and account for approximately 10% of all measles infections.
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Source: CDC: Measles Cases and Outbreaks. Centers for Disease Control and Prevention (CDC). 2026; Published: August 7, 2026.
Global Forecasts Reveal Rising Antimicrobial Resistance Threats in Children
Global pediatric antimicrobial resistance increased from 2004 to 2022 across all regions. Resistance was highest among Gram-negative pathogens, children in intensive care, those with sepsis, and resource-limited settings. By 2035, carbapenem resistance is projected to reach 35% in Klebsiella species and 82% in Acinetobacter baumannii.
KEY FINDINGS: This global pediatric surveillance study demonstrates a sustained increase in antimicrobial resistance among children, with the greatest concern involving Gram-negative pathogens, intensive care settings, sepsis cases, and resource-limited regions. Increasing resistance to Watch and Reserve antibiotics may compromise treatment options for severe childhood infections. Forecasted growth in carbapenem resistance among Klebsiella species and Acinetobacter baumannii highlights the need for strengthened antimicrobial stewardship, surveillance systems, and development of effective pediatric treatment strategies.
BACKGROUND: Antimicrobial resistance (AMR) threatens the effectiveness of antibiotic therapy for severe childhood infections, yet comprehensive pediatric AMR surveillance data across multiple regions remain limited. This study evaluated global and temporal patterns of antimicrobial resistance among children using the World Health Organization (WHO) Access, Watch, and Reserve (AWaRe) antibiotic classification framework and projected future resistance trends
DETAILS: This cross-sectional surveillance study analyzed pediatric bacterial isolates from the Antimicrobial Testing Leadership and Surveillance (ATLAS) database collected between January 2004 and December 2022. The study included 106 581 isolates from 106 581 children aged 0 to 18 years across 82 countries. Data were analyzed from February 2024 to April 2026. Resistance trends were assessed by geographic region, age group, clinical setting, infection syndrome, and pathogen type, with spatiotemporal models used to forecast resistance patterns through 2035.
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The analysis categorized antibiotics according to the WHO AWaRe framework: Access antibiotics used for first-line treatment, Watch antibiotics with higher resistance potential, and Reserve antibiotics intended for difficult-to-treat infections. The study evaluated WHO priority pathogens and examined resistance patterns among different pediatric populations, including children with sepsis and respiratory infections.
From 2004 to 2022, pediatric AMR increased across all regions, with higher resistance levels and faster increases observed in resource-limited settings. Resistance to Access-group antibiotics was highest overall, with a mean resistance of 36% (range, 2%-66%), compared with Watch-group antibiotics at a mean of 22% (range, 1%-47%) and Reserve-group antibiotics at a mean of 13% (range, 0%-30%).
Resistance to higher-tier antibiotics increased substantially in vulnerable clinical groups. In intensive care units, Watch-group resistance increased from 15% (517/3564) to 33% (2910/8748) (P < .001), particularly among children aged 0 to 2 years, where resistance increased from 12% (325/2649) to 32% (1257/3959) (P < .001). Among children with sepsis, Watch-group resistance increased from 15% (298/2030) to 30% (1409/4705) (P < .001), while Reserve-group resistance increased from 3% (16/474) to 26% (746/2824) (P < .001).
Among critical pathogens, Acinetobacter baumannii demonstrated the highest overall resistance, exceeding 55% in every AWaRe antibiotic category in 2022. Klebsiella species showed the fastest increases in resistance, particularly to third- or fourth-generation cephalosporins and carbapenems. Forecasts estimated that by 2035, carbapenem resistance would reach 35% (95% uncertainty interval [UI], 29%-40%) in Klebsiella species and 82% (95% UI, 77%-85%) in A baumannii.
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Source: Hu, Y. J., Qiu, H., Harwell, J. I., et al. Childhood Antimicrobial Resistance With Global Forecasts. JAMA Pediatrics. 2026; Published: July 20, 2026. DOI: 10.1001/jamapediatrics.2026.2808.
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