Candida Drug Resistance in Patients With Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis

Area of Science:

• Medical Mycology
• Infectious Diseases
• Dermatology

Background:

• Diabetic foot ulcers (DFUs) are severe complications of diabetes, potentially leading to amputation.
• Fungal infections, especially by Candida species, complicate DFU management.
• Emerging antifungal drug resistance in Candida poses a significant threat to DFU treatment outcomes.

Purpose of the Study:

• To systematically review and meta-analyze the prevalence of drug-resistant Candida species in diabetic foot ulcers.
• To identify specific Candida species and their resistance patterns to various antifungal agents in DFUs.
• To evaluate the efficacy of different antifungal drugs against Candida in the context of DFUs.

Main Methods:

• Systematic search of PubMed, Web of Science, Scopus, and Google Scholar databases up to June 22, 2024.
• Inclusion of studies reporting on Candida diabetic foot infections and drug resistance data.
• Analysis of data including fungal species, resistance percentages, and drug efficacy.

Main Results:

• Candida albicans was the most common species, followed by C. tropicalis and C. parapsilosis.
• High resistance rates were observed for Nystatin (32.48%), Itraconazole (19.46%), and Fluconazole (16.4%).
• Lower resistance rates were found for Miconazole (1.18%) and Caspofungin (4.69%). Resistance was higher in C. albicans than non-albicans species.

Conclusions:

• Antifungal drug resistance in Candida species is a significant concern in patients with DFUs.
• Itraconazole and fluconazole show considerable resistance, while Caspofungin, micafungin, and voriconazole demonstrate greater effectiveness.
• Prioritizing antifungal agents with lower resistance rates is crucial for improving treatment outcomes and reducing failure in DFU patients.