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Published on: December 28, 2017
Susceptibility pattern of Candida albicans isolated from Iranian patients to antifungal agents
1Professor, Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Background And Purpose:
Candidiasis is a major fungal infection, and Candida albicans is the major cause of infections in humans. The Clinical and Laboratory Standards Institute (CLSI) developed new breakpoints for antifungal agents against C. albicans. In this multi-center study, we aimed to determine the drug susceptibility profile of C. albicans, isolated from Iranian population according to new species-specific CLSI.
Materials And Methods:
Clinical samples were cultured on Sabouraud dextrose agar and were incubated at room temperature for seven days. The isolates were transferred to Professor Alborzi Clinical Microbiology Research Center, Shiraz, Iran. C. albicans were identified by using API 20C AUX system. Broth microdilution method was used to determine the minimum inhibitory concentrations (MICs) of amphotericin B, caspofungin, voriconazole, fluconazole, posaconazole, itraconazole, and ketoconazole, based on CLSI document M27-S4 and new breakpoints for some azoles and caspofungin.
Results:
Overall, 397 C. albicans were isolated from patients admitted to ten university hospitals in Iran. The MIC90 of the isolates to amphotericin B, caspofungin, voriconazole, fluconazole, posaconazole, itraconazole, and ketoconazole were 0.125, 0.125, 0.125, 1, 0.064, 0.5, and 0.125 µg/ml, and rates of resistance were 0.5%, 0.3%, 3.8%, 2.8%, and 2.5% for amphotericin B, caspofungin, voriconazole, fluconazole, and itraconazole, respectively.
Conclusion:
According to our data, fluconazole is the drug of choice for management of patients at risk for systemic candidiasis throughout the region, since it is cost-effective with low side effects.
Insights
This study assessed the antifungal drug susceptibility of Candida albicans in Iran using new CLSI breakpoints. Fluconazole emerged as the preferred treatment for systemic candidiasis due to its efficacy and safety profile.
Area of Science:
- Medical Mycology
- Clinical Microbiology
- Infectious Diseases
Background:
- Candidiasis, a significant fungal infection, is primarily caused by Candida albicans.
- The Clinical and Laboratory Standards Institute (CLSI) has introduced updated breakpoints for antifungal agents targeting C. albicans.
Purpose of the Study:
- To determine the antifungal drug susceptibility profile of Candida albicans isolates from the Iranian population.
- To evaluate susceptibility based on the latest CLSI species-specific breakpoints.
Main Methods:
- Collected clinical samples from ten university hospitals in Iran.
- Identified Candida albicans using the API 20C AUX system.
- Determined minimum inhibitory concentrations (MICs) via broth microdilution for seven antifungal agents, adhering to CLSI M27-S4 guidelines and new breakpoints.
Main Results:
- 397 Candida albicans isolates were analyzed.
- High susceptibility was observed for most antifungals, with notable MIC90 values.
- Resistance rates were low: Amphotericin B (0.5%), Caspofungin (0.3%), Voriconazole (3.8%), Fluconazole (2.8%), and Itraconazole (2.5%).
Conclusions:
- Fluconazole is recommended as the primary treatment for systemic candidiasis in the region.
- Fluconazole's cost-effectiveness and low side effect profile support its use.
- The findings provide crucial data for antifungal stewardship in Iran.
