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Life sciences · Review
Journal of Clinical Microbiology · October 27, 2026
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), first described in 2009, has spread to 82 countries across 6 continents, with more than 84,000 cumulative colonization and infection cases reported through December 2025. Whole-genome sequencing has resolved the species into six deeply divergent clades (I-VI) that differ geographically and in antifungal susceptibility. This minireview synthesizes peer-reviewed literature and public health surveillance data on whole-genome-sequencing-confirmed clade distribution and susceptibility across the United States, the European Union/European Economic Area, the United Kingdom, Latin America and the Caribbean, Saudi Arabia and the wider Gulf region, Canada, Singapore, Australia, and New Zealand. Clades I and III are now the most geographically widespread outbreak-associated lineages, documented across nearly every region reviewed. The United States has diversified from early clade I dominance to a four-clade landscape by 2013-2022 (clade I, 56.0%; clade III, 29.4%; clade IV, 14.1%; and clade II, 0.5%). Latin America remains the principal reservoir of clade IV; Saudi Arabia and the Gulf region are dominated by clade I, and the discovery of clade VI in Singapore and Bangladesh illustrates continuing genomic diversification. Clade I carries the highest burden of multidrug and pan-resistance; clade III shows high fluconazole resistance but lower echinocandin resistance; and clade IV, historically associated with lower resistance, is now rising. Because regional antifungal resistance largely reflects clade composition rather than independent regional drift, clade-aware surveillance should directly inform local stewardship, diagnostic inclusivity, and regulatory bridging across markets.