Our current clinical understanding of Candida biofilms: where are we two decades on?

Gordon Ramage, Elisa Borghi, Célia Fortuna Rodrigues, Ryan Kean, Craig Williams, Jose Lopez‐Ribot

Clinically we have been aware of the concept of Candida biofilms for many decades, though perhaps without the formal designation. Just over twenty years ago the subject emerged on the back of progress made from the bacterial biofilms, and academic progress pace has continued to mirror the bacterial biofilm community, albeit at a decreased volume. It is apparent that Candida species have a considerable capacity to colonise surfaces and interfaces and form tenacious biofilm structures, either alone or in mixed species communities. From the oral cavity, to the respiratory and genitourinary tracts, wounds, or in and around a plethora of biomedical devices, the scope of these infections is vast. These are highly tolerant to antifungal therapies that has a measurable impact on clinical management. This review aims to provide a comprehensive overight of our current clinical understanding of where these biofilms cause infections, and we discuss existing and emerging antifungal therapies and strategies.