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Emergence of Fluconazole-resistant Candida Infections in Diabetic Foot Ulcers: Implications for Public Health
Chankramath S Arun1, Priyanka Raju1, Vivek Lakshmanan1
1Department of Podiatry and Endocrinology, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
Background:
It is well documented in the literature that fungal infections are common in diabetic foot ulcers (DFUs). This has led to an overuse of antifungal agents, namely fluconazole, with a consequent risk of emergence of resistance to this drug. Previous studies have shown a 3.9% prevalence of fluconazole resistance in DFU, but limited data exist regarding the change in resistance pattern over the last decade.
Objectives:
Our aim was to study the prevalence of resistance to fluconazole in patients with DFU and culture-proven fungal infections.
Materials And Methods:
We retrospectively studied 1438 patients with type 2 diabetes and nonhealing foot ulcers who had fungal cultures performed during the course of their treatment. The data were collected for all patients who presented to our foot clinic over a period of 18 months.
Results:
The prevalence of positive fungal culture was 17.38% (250/1438). 151/200 positive cultures belonged to Candida species. Resistance to fluconazole was observed in 9.3% (17/200). The most common organism with resistance to fluconazole was Candida auris (10/17).
Conclusions:
High prevalence of fluconazole resistance is a potential cause of concern, and the rational use of this drug is important in the community. The above results could have an impact on public health, as fluconazole is one of the safest and effective oral antifungal agents available. The spread of resistance could have implications for its use in other situations including systemic fungal infections.
Insights
Fluconazole resistance in fungal infections of diabetic foot ulcers (DFUs) is a growing concern. This study found a 9.3% resistance rate, with Candida auris being the most common resistant organism.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Diabetology
Background:
- Fungal infections are prevalent in diabetic foot ulcers (DFUs), leading to overuse of fluconazole.
- This overuse increases the risk of antifungal resistance, with prior studies noting a 3.9% resistance rate.
- Limited data exist on resistance trends over the past decade.
Purpose of the Study:
- To investigate the prevalence of fluconazole resistance in patients with DFUs and confirmed fungal infections.
- To update current understanding of antifungal resistance patterns in this vulnerable population.
Main Methods:
- Retrospective analysis of 1438 patients with type 2 diabetes and nonhealing foot ulcers.
- Inclusion of patients who underwent fungal cultures during an 18-month period at a dedicated foot clinic.
- Review of culture results to identify fungal species and assess fluconazole susceptibility.
Main Results:
- A 17.38% prevalence of positive fungal cultures was observed (250/1438).
- Candida species were identified in 151 of 200 positive cultures.
- An overall fluconazole resistance rate of 9.3% (17/200) was detected, with Candida auris being the most frequent resistant species (10/17).
Conclusions:
- The observed 9.3% fluconazole resistance rate in DFUs is a significant public health concern.
- Rational use of fluconazole is crucial in community settings to mitigate further resistance.
- Rising resistance may impact the efficacy of fluconazole for systemic fungal infections.
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