Cellular and Molecular Perspectives into the General Mechanisms of Antifungal Resistance in Iraq; a systematic review

Abstract

With the emergence of new isolates of human pathogenic fungi and the spread of resistance among known strains, especially among Candida species that are frequent causative agents responsible for fungal infections; their reasons however, vary. This complicates diagnosis and treatment. Hence, this issue requires a strategic approach comprising enhancement of laboratory practices; creation of new drugs; establishing responsible drug regulation and strong environmental monitoring. Due to the significant increase in antifungal resistance in Iraq reported by previous studies during the last five years, this review aimed to focus on antifungal resistance in Iraq, its causes based on these studies, recommendations and even research gaps and outstanding issues. This study has reviewed the reliable scientific databases and academic search engines (PubMed, Scopus + Google scholar) for collecting original studies regarding antifungal resistance in clinical or environmental fungal isolates from Iraq (the period from 2020 to 2025). Due to the large amount of variation in study characteristics identified across studies, and where some reports lacked numerical data, we performed a descriptive analysis rather than a meta-analysis. Eight original studies were conducted in different Iraqi governorates. All results were summarized in a detailed table displaying the year of publication, study location, antifungals tested, species of Candida that antifungal susceptibility was performed against breve number of resistant isolates and respective total number of isolates. The aim is to use this approach to compare resistance in different Iraqi regions and clinical settings, appropriately from a methodological point of view. Candida albicans and other species of the genus Candida are the predominantly isolated pathogens showing reliably resistance to widely used antimycotic agents, especially azoles (especially fluconazole). This resistance is becoming an increasing problem in Iraq, thereby requiring closer monitoring, a standardized susceptibility testing, and more multicenter studies.