Candidemia is a leading cause of nosocomial bloodstream infections, associated with high mortality and substantial healthcare costs. Management challenges primarily arise from diagnostic delays due to the limitations of conventional methods, along with the difficulty in optimizing antifungal regimens. This review provides a comprehensive analysis of these issues, beginning with an overview of the epidemiology, species distribution, and origins of candidemia. It then focuses on the need for improved diagnostic technologies and the importance of susceptibility-guided therapy in enhancing patient outcomes and combating resistance. The article assesses current diagnostic approaches, their limitations, and emerging technologies that may enhance detection performance. Therapeutic strategies are examined in detail, including empiric and targeted regimens, management of mixed infections, and host-drug interactions. Particular emphasis is placed on antifungal resistance and the potential of combination therapy. Advances in drug development are also highlighted, covering agents in clinical trials and compounds targeting novel fungal pathways. Finally, future directions are explored, such as the application of artificial intelligence in diagnostics, vaccine-based prophylaxis, and synergistic treatment strategies. By synthesizing recent progress, this review aims to support clinicians and researchers in addressing the evolving challenges of candidemia management.

Fungal infections caused by Candida albicans have posed a persistent threat to human health. Existing clinical antifungal drugs are constrained by issues such as drug resistance and side effects. Compounds containing maleimide rings have been verified to possess antifungal properties, although the specific molecular mechanisms by which they exert this activity have yet to be fully understood. A total of 40 compounds containing maleimide rings were synthesised in the present study, and 12 derivatives that possessed antifungal properties were subsequently identified. The maleimide compound 5 (MPD) with the most potent activity demonstrated fungicidal action at a concentration that was twice as potent as the minimal inhibitory concentration and effectively prevented the formation of biofilms. Furthermore, the mechanistic studies revealed that MPD interfered with iron ion homoeostasis by reducing intracellular iron concentration inside cells, which led to the inhibition of ergosterol biosynthesis and increased cell membrane permeability, resulting in the leakage of intracellular trehalose. In addition, MPD was observed to perturb cell wall biosynthesis by reducing the activity of chitin synthase. Moreover, MPD was found to demonstrate therapeutical efficacy in vivo when assessed using a Caenorhabditis elegans C. albicans infection model.