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In Vitro Activity of Caspofungin Against Fluconazole-Resistant Candida Species Isolated From Clinical Samples in Iran
Hamideh Shekari Ebrahim Abad1, Farideh Zaini1, Parivash Kordbacheh1
1Department of Parasitology and Mycology, School of Public Health, Institute of Public Health Researches, Tehran University of Medical Sciences, Tehran, IR Iran.
Background:
Candida spp. is the most common organisms involved in fungal infections in the high risk patients. It causes the greatest number of invasive candidiasis. Fluconazole is effective in treating mucosal candidiasis. However, resistance to fluconazole and other azoles antifungal drugs is an important clinical problem to treat candidiasis. Caspofungin is more effective against Candida species such as some azoles-resistant isolates.
Objectives:
The current study aimed to investigate the susceptibilities of clinical fluconazole-resistant and fluconazole - susceptible dose- dependent Candida species to caspofungin.
Materials And Methods:
In the Minimum Inhibitory Concentration (MIC) test, 207 Candida species and other yeasts isolated from Iranian patients (each isolated from a high-risk patient) were evaluated. The yeasts were differentiated by standard mycological methods, CHROM agar Candida, and verified by API20C.AUX. In vitro susceptibilities were determined using Broth Micro Dilution (BMD) method described in the Clinical Laboratory Standards Institute M27-A3. MICs were noted after 24 and 48 hours of incubation.
Results:
The most frequently isolated species were Candida albicans (52.2%), C. glabrata (24.6%), followed by C. tropicalis (7.7%) and C. krusei (3.4%). MICs of caspofungin against 87% of C. albicans and 90% of C. glabrata and C. tropicalis isolates were 2 μg/mL and for C. krusei were 4 μg/mL, respectively. The results revealed that only 20 out of 207 isolates (9.7%) were non-sensitive to caspofungin. Caspofungin non-susceptible isolates were isolated from the patients with cancer, diabetes and AIDS; and not in the species isolated from patients with other underlying diseases.
Conclusions:
Caspofungin appears more effective in vitro against Iranian fluconazole-resistant Candida isolates and some other yeasts.
Insights
Caspofungin demonstrates high in vitro effectiveness against fluconazole-resistant Candida species commonly found in Iranian high-risk patients. This antifungal offers a promising alternative where azole resistance is a significant clinical concern.
Area of Science:
- Mycology
- Infectious Diseases
- Antimicrobial Resistance
Background:
- Candida species are leading causes of fungal infections in high-risk patients, with invasive candidiasis posing a significant threat.
- Fluconazole resistance in Candida is a growing clinical challenge, necessitating alternative treatments.
- Caspofungin shows potential efficacy against azole-resistant Candida isolates.
Purpose of the Study:
- To evaluate the in vitro susceptibility of clinical fluconazole-resistant and fluconazole-susceptible dose-dependent Candida species to caspofungin.
- To assess the effectiveness of caspofungin against a range of Candida species isolated from Iranian patients.
Main Methods:
- 207 Candida and yeast isolates from high-risk Iranian patients were identified using standard mycological methods and API20C.AUX.
- In vitro antifungal susceptibility testing was performed using the Broth Micro Dilution (BMD) method (CLSI M27-A3).
- Minimum Inhibitory Concentrations (MICs) for caspofungin were determined after 24 and 48 hours of incubation.
Main Results:
- Candida albicans (52.2%), C. glabrata (24.6%), C. tropicalis (7.7%), and C. krusei (3.4%) were the most common isolates.
- Caspofungin exhibited potent activity, with MICs of 2 μg/mL for 87% of C. albicans and 90% of C. glabrata and C. tropicalis isolates.
- Only 9.7% of isolates were non-susceptible to caspofungin, primarily found in patients with cancer, diabetes, and AIDS.
Conclusions:
- Caspofungin demonstrates significant in vitro efficacy against fluconazole-resistant Candida isolates from Iran.
- The findings suggest caspofungin as a viable therapeutic option for invasive candidiasis, particularly in cases of azole resistance.
- Further clinical studies are warranted to confirm caspofungin's effectiveness in treating candidiasis in immunocompromised patients.
