Efficacies of Echinocandins versus Azoles Antifungal agents in Management of Candidaalbicans andCandida dubliniensis

Abstract

Candidalinfectionis aworld-wide problem with greatly-changed epidemiology.Candida dubliniensis is an emerging non-albicans, shares several phenotypic and genotypic characteristics andclosely related toCandidaalbicans. Fluconazole-resistant Candidabecome asignificant life-threatening problem especially in high risk patients. Echinocandins are promising antifungals with no recorded resistance.This study was done, first to differentiate Candidadubliniensis from Candidaal bicansby different phenotypic and molecular methods and to compare in vitro activities of echinocandins against Candida spp versus azoles. Subjects and Methods:one hundred fifty-seven oral and vaginal swabs collected from Dermatology outpatients of Zagazig University Hospitals. Cultivation was done on Brilliance Candida agar. Growth at elevated temperature;tobacco agar VITECK2-YST and PCRwere evaluated. Antifungal susceptibility testing was done to Candidaalbicans and Candida dubliniensis to fluconazole and caspofungin by microdilution method ResultsA total of 76 Candida isolates were identified. Most of them(61.8%) were Candida albicans, followed by Candida glabrata,Candida dubliniensis and the least was C. krusei (14.5%),(13.2%) and (10.5%) respectively. For further differentiation betweenC.albicans and C.dubliniensis, PCR hadthe highest sensitivity (100%) however, tobacco agar, growth at elevated temperature and VITECK2-YSThad (82.5%), (59.6%) and (84.2%) sensitivities respectively. The Percentage of fluconazole-resistant Candida dubliniensisand Candida albicans were (55.6%) and 23(49%) withMIC ≥64μg/ml. BothCandida albicansand Candida dubliniensis isolates were (100%) sensitive to caspofungin at MIC range of 0.06-1μg/ml. ConclusionBrillance Candida Agar is a reliable-test, for differentiation of Candidaspp,Caspofungin showed activity against fluconazole-resistant C. albicansand C.dubliniensis.