Candida Antifungal Susceptibility Research Articles

Isolation and Antifungal Susceptibility of Candida spp. from Pediatric Patients in Kurdistan of Iraq

Candida species are considered the most common opportunistic human fungal pathogen due to the presence of various virulence factors, including its ability to form a biofilm that aids in oral candidiasis. Pediatric patients are more susceptible to oral candidiasis than healthy pediatric because of the factors that encourage Candida oral carriage. This current study aims to isolate, evaluated the antifungal effect on Candida spp. and participated in oral candidiasis of pediatric patients in Sulaymaniyah and Kirkuk city. The study was performed from September 2021 to February 2022 on two groups of pediatrics which including pediatric patients (n=160) and healthy pediatric (n=50) as a control group. Oral swabs were obtained from 210 participants in the Kurdistan Region of Iraq at the Pediatric teaching hospital of the Sulaymaneyah and Kirkuk governorates. To culture the swabs, Sabouraud dextrose agar (SDA) medium was used. HiCrome™ Candida Differential agar used to identify Candida isolated, then depending on the internal transcribed spacer (ITS) region using confirmed polymerase chain reaction. Antifungal sensitivity was done for all C. albicans and non-albicans isolates using five common antifungal disks. Among of the 160 sample of pediatric patient 62 (38.8%) positive for Candida spp. which it is including 17 (27.4 %) and 26 (41.9%), 19 (30.6%) breast feeding, bottle feeding and mixing respectively. While within 50 samples of control group 13 (26%) were positive for Candida spp. which including 2 (15.4%), 9(69.2%), 2(15.4%) of same respectively feeding types. Regarding to the antifungal susceptibility the results showed that C. albicans had higher resistance rates against itraconazole, ketoconazole, and clotrimazole than the non-albicans Candida species However, highly resistant rate were detected in Itraconazole and Ketoconazole with 23.7% and 54.4% respectively, for all Candida species. The Current study concluded that oral candidiasis was more predominant in pediatric patients in compare to healthy pediatric also, and C. albicans is the most prevalent etiologic agent. However, higher rate of sensitivity were detected between Candida species for nystatin, which may suggest as the main treatment for oral Candida infections.

Species Distribution and Antifungal Susceptibility of Candida spp. responsible for Pulmonary Candidiasis

Fungal infection can occur in almost all parts of the human body, including the respiratory system. One group of fungi causing opportunistic infections in the lungs also known as pulmonary candidiasis is Candida spp. This study aimed to determine species diversity and antifungal sensitivity of Candida sp. causing pulmonary candidiasis from sputum specimen isolates in the Zainoel Abidin Hospital (ZAH). The sputum specimens were from inpatients and outpatients during a period of January 2019 to January 2021. Identification of Candida spp. and the antifungal sensitivity were carried out using culture and Gram Staining as well as the VITEK® 2 Compact. The results of this study indicated that there were six species of Candida sp. obtained from the study period. Of total 73 isolates, the highest percentage of species was Candida albicans (56.16%). The percentage of pulmonary candidiasis based on age was dominated by the early-late age category 46-65 years (50.68%) and based on sex was dominated by men (71.23%). Antifungal susceptibility assays revealed that the Candida species remained highly susceptible to the antifungals (amphotericin B, caspofungin, flucytosine, fluconazole, micafungin, and voriconazole), i.e., greater than 91 percent. Overall, the results of this study indicated that pulmonary candidiasis were predominantly related to C. albicans and C. tropicalis infections in ZAH and the sensitivity of antifungal drugs remained empirically and definitively effective. This research might be important as a part of infection prevention and control strategies, as well as the administration of empirical antifungals to combat Candida-mediated lung infections.

Molecular Epidemiology, Antifungal Susceptibility, and Virulence Evaluation of Candida Isolates Causing Invasive Infection in a Tertiary Care Teaching Hospital.

BackgroundThe incidence of invasive candidiasis is increasing worldwide. However, the epidemiology, antifungal susceptibility, and virulence of Candida spp. in most hospitals remain unclear. This study aimed to evaluate invasive candidiasis in a tertiary care hospital in Nanchang City, China.MethodsMALDI-TOF MS and 18S rDNA ITS sequencing were used to identify Candida strains. Randomly amplified polymorphic DNA analysis was used for molecular typing; biofilm production, caseinase, and hemolysin activities were used to evaluate virulence. The Sensititre™ YeastOne YO10 panel was used to examine antifungal susceptibility. Mutations in ERG11 and the hotspot regions of FKS1 of drug-resistant strains were sequenced to evaluate the possible mechanisms of antifungal resistance.ResultsWe obtained 110 Candida strains, which included 40 Candida albicans (36.36%), 37 C. parapsilosis (33.64%), 21 C. tropicalis (19.09%), 9 C. glabrata (8.18%), 2 C. rugose (1.82%), and 1 C. haemulonii (0.91%) isolates. At a limiting point of 0.80, C. albicans isolates could be grouped into five clusters, C. parapsilosis and C. tropicalis isolates into seven clusters, and C. glabrata isolates into only one cluster comprising six strains by RAPD typing. Antifungal susceptibility testing revealed that the isolates showed the greatest overall resistance against fluconazole (6.36%), followed by voriconazole (4.55%). All C. albicans and C. parapsilosis isolates exhibited 100% susceptibility to echinocandins (i.e., anidulafungin, caspofungin, and micafungin), whereas one C. glabrata strain was resistant to echinocandins. The most common amino acid substitutions noted in our study was 132aa (Y132H, Y132F) in the azole-resistant strains. No missense mutation was identified in the hotpot regions of FKS1. Comparison of the selected virulence factors detectable in a laboratory environment, such as biofilm, caseinase, and hemolysin production, revealed that most Candida isolates were caseinase and hemolysin producers with a strong activity (Pz < 0.69). Furthermore, C. parapsilosis had greater total biofilm biomass (average Abs620 = 0.712) than C. albicans (average Abs620 = 0.214, p < 0.01) or C. tropicalis (average Abs620 = 0.450, p < 0.05), although all C. glabrata strains were either low- or no-biofilm producers. The virulence level of the isolates from different specimen sources or clusters showed no obvious correlation. Interesting, 75% of the C. albicans from cluster F demonstrated azole resistance, whereas two azole-resistant C. tropicalis strains belonged to the cluster Y.ConclusionThis study provides vital information regarding the epidemiology, pathogenicity, and antifungal susceptibility of Candida spp. in patients admitted to Nanchang City Hospital.

Antifungal susceptibility of clinically significant candida species by disk diffusion method

Antifungal susceptibility of candida. To perform antifungal susceptibility testing on candida isolates by disk diffusion method &amp; study its susceptibility pattern. The present study was conducted in the department of Microbiology in a tertiary care hospital in Hyderabad from January 2013 to June 2014, with prior approval of the Institutional Ethics Committee. The present study was designed to perform antifungal susceptibility test on Candida isolates by Disk Diffusion Method and study its susceptibility pattern. 102 Candida isolates were subjected to Antifungal susceptibility testing by Disk diffusion method using Mueller-Hinton Agar + 2% Glucose and 0.5 μg/mL Methylene Blue Dye (GMB) Mediumas per CLSI guidelines. : Antifungal susceptibility test shows that C. albicans is more susceptible to all the antifungal agents tested. Resistance to azole group of drugs was more pronounced in non-albicans candida spp. Voriconazole seemed to be superior to Fluconazole with a better susceptibility in the Fluconazole resistant strains also.Findings of the antifungal susceptibility test suggest that Candida spp., differ in their susceptibility to antifungal agents. Antifungal susceptibility testing of Candida isolates will be helpful in guiding physicians to select the appropriate antifungal drug so that therapeutic failures can be avoided thus decreasing patient morbidity and mortality.

An in vitro study on the antifungal and antibiofilm activities of probiotic bacteria against Candida species isolated from orthodontic appliances and dental caries

Candida species are opportunistic pathogens that may cause infections in predisposed persons. This work aimed to detect the antifungal and antibiofilm potentials of Lactobacillus acidophilus and Lactobacillus plantarum supernatants on Candida spp. About 60 % and 80 % of Candida isolates were recovered from saliva samples of 20 patients with fixed orthodontic appliances, and 20 children having dental caries, respectively. The antifungal susceptibility of Candida spp. was investigated using disk diffusion assay. C. albicans strains showed low resistance to fluconazole (15 %) and amphotericin B (10 %). Using the agar well diffusion assay, both L. acidophilus and L. plantarum supernatants inhibited the in vitro growth of all tested Candida spp. with inhibition zone diameters of (11-19 mm) and (7-16 mm), respectively. On observing the effects of L. plantarum and L. acidophilus supernatants on Candida cells’ morphology; the light microscopic examination demonstrated the inhibition in germ tube formation of all tested C. albicans with percentages of 68 % and 53 %, and for C. krusei with inhibition percentages of 69 % and 59 %, respectively. L. acidophilus and L. plantarum strains showed high co-aggregation ability with C. albicans strains with ranges of 42-49 % and 30-35 %, respectively. The antibiofilm activities of the two Lactobacillus supernatants were determined using the tissue culture plate assays. Significant inhibition of biofilms formation by Candida spp. was recorded on treatment with L. plantarum and L. acidophilus supernatants, with reduction percentages of 50-72 % and 74-85 %, respectively.

Frequency and antifungal susceptibility of Candida spp. (other than C. albicans) isolated from patients admitted to critical care units of a third-level hospital in northern Peru

Objective: To determine the frequency and antifungal susceptibility of Candida spp. (other than C. albicans) isolated from samples of patients admitted to critical care units of a third-level hospital in northern Peru.Materials and methods: A cross-sectional study was conducted between February 2018 and May 2019 in 232 samples of patients admitted to critical care units of the Hospital Regional Lambayeque (HRL). Candida spp. (other than C. albicans)were identified using phenotypic tests. The antifungal susceptibility to fluconazole and voriconazole was determined according to the epidemiological cut-off values of CLSI document M44-A2. Results: Two hundred thirty-two (232) samples were analyzed. The frequency of Candida spp. (other than C. albicans)was 19.82 % (46/232) and C. albicans was 11.20 % (26/232). Candida spp. (other than C. albicans) were the following: C. tropicalis (67.39 %, 31/46), C. glabrata (17.39 %, 8/46), C. parapsilosis (10.86 %, 5/46) and C. krusei (4.34 %, 2/46). Patients from whom Candida spp. (other than C. albicans) were isolated were mostly females (56.52 %), had a historyof antimicrobial drugs consumption (67.39 %) and were 60 years of age and older (36.95 %). Most microorganisms were isolated from urine samples (45.65 %). Regarding the antifungal susceptibility of Candida spp. (other than C. albicans), 19.56 % and 21.73 % were resistant to fluconazole and voriconazole, respectively.Conclusions: The high incidence and prevalence of Candida spp. (other than C. albicans) in patients admitted to critical care units of a third-level hospital in Chiclayo, together with resistance to fluconazole and voriconazole, are significant inthe morbidity and mortality of these patients.

Epidemiology and Antifungal Susceptibility in Patients with Candidemia in a University Hospital, Thailand

Background: Candidemia is the most common nosocomial invasive fungal infection that causes high mortality. Emergence of drug-resistant Candida is reported worldwide but there are few studies in Thailand. Objective: To determine the epidemiology, antifungal susceptibility of Candida, and outcomes among adult patients with candidemia. Materials and Methods: A prospective, observational study in adult patients with candidemia was conducted in 2015 at a university hospital. Demographic, microbiological, and outcome data were recorded. Results: Fifty-two patients with candidemia were identified, of whom 76.9% had an underlying disease and 69.2% had risks for candidemia. Sixty-four percent of candidemia patients contracted non-albicans Candida and 36% had Candida albicans. C. tropicalis was the most common non-albicans Candida species isolated (35%), followed by C. parapsilosis (19%), and C. glabrata (10%). Fluconazole resistance was found in 12.5% of C. albicans and in 11.1% of C. parapsilosis isolates. Reduced fluconazole susceptibility or high-level fluconazole resistance was found in 68.7% of C. tropicalis isolates. All except C. parapsilosis had excellent susceptibility to echinocandins. Seventy-three percent (38/52) of patients received antifungal treatment, of whom, 78.9% received empiric fluconazole therapy, and 89.7% were started on antifungal treatment 24 hours after the isolation of Candida. The overall mortality rate was 51.9%. Conclusion: Fluconazole-resistant Candida became more prevalent particularly in C. tropicalis, which was the predominant species among non-albicans Candida causing candidemia. Empiric treatment with either amphotericin B or echinocandins would be appropriate in high-risk patients with suspected candidemia. Trial registration: Thai Clinical Trials Registry, TCTR20150605001 Keywords: Candida, Fluconazole, Resistant, Thailand

Molecular identification and antifungal susceptibility profile of yeast from vulvovaginal candidiasis

BackgroundAccurate identification Candida is important for successful therapy and epidemiology study. The aim of research is to study API 20C yeast identification system identification rate by using molecular identification as gold standard and tested the antifungal susceptibility of Candida from patients with vulvovaginal candidiasis (VVC).MethodsIn total, 3574 yeast isolates were obtained from patients with VVC. API 20C yeast identification, molecular identification and in vitro antifungal susceptibility were performed.ResultsC. albicans was the predominant Candida species [2748 isolates, 76.9%] in VVC. The isolates from vaginal samples represented 22 species based on molecular identification. The API 20C system identifies only 11 of the species encountered during the study period. Based on the API 20C system, 3273 (91.58%) isolates were correctly identified to the species level. The correct identification rate of the API 20C system for rare yeast was 15.29% (26/170 isolates). Antifungal susceptibility was tested in a total of 1844 isolates of Candida from patients with VVC. C. albicans was susceptible to most of the tested antifungals. The MICs of azoles for C. glabrata were higher than those for C. albicans. The MICs of echinocandins for C. parapsilosis were higher than those for C. albicans.ConclusionsThe API 20C yeast identification system can be used to reliably identify the most common Candida species while molecular methods are necessary for the identification of closely related, emerging, and rare yeast species. The results from this study suggest that much of the previous studies on the epidemiology of VVC should be re-thought. C. albicans was susceptible to most of the tested antifungals.

Klonska raznolikost i antifungalna osjetljivost vrste Candida spp. izolirane iz mlijeka

The aim of this study was the isolation, identification, phylogenetic analysis and antifungal susceptibility of Candida spp. from milk samples of healthy and mastitic cows in Kayseri/Turkey. Milk samples from 300 cows were found to be negative/positive for mastitis with the California Mastitis Test. Candida spp. was isolated by using the Brillance Candida Agar Base. Phenotypic tests, Matrix Assisted Laser Desorption Ionization - Time of Flight (MALDI-TOF), and VITEK-2 analyses were applied to confirm the obtained isolates. Resistance to flucytosine, fluconazole and caspofungin antifungals of the isolates were determined by Etest and VITEK-2. The genetic homologies of Candida spp. isolates were determined by Repetitive Extragenic Palindromic-PCR (RepPCR). In this study 62 (from 53 healthy, 9 mastitic) yeast isolates were obtained and 37 (59.6 %) were identified as non-albicans Candida (NAC) species. Phenotypic tests revealed that out of 62 isolates, 29 (46.7 %), 4 (6.5 %), 3 (4.8 %), 1 (1.6 %) and, 24 (38.7 %) were identified as Candida lusitaniae, Candida catenulate, Candida tropicalis, Candida silvicola and other yeast species, respectively. Only one sample (1.6 %) was identified as Candida albicans by MALDI-TOF however, according to VITEK-2, the agent was not confirmed as C. albicans. According to antifungal susceptibility testing by VITEK-2, one (2.7 %) of the isolates was resistant to fluconazole, one (2.7 %) was resistant to caspofungin, and 4 (10.8 %) were resistant to flucytosine. However, using E test, 10 isolates (27 %) were resistant to flucytosine. Using Rep-PCR, eight genotypic clones were observed. Genotype F (13.8 %) and G (13.8 %; 2 subtypes) were common clones in this study. In conclusion, NAC species were detected in healthy and mastitic cow milk samples. Epidemiological studies need to be conducted to track effectively the main source and to understand the diversity and distribution of the agent. It is necessary to consider the potential risks of yeast contamination in milk for public health. It is essential to focus on adequate sanitation procedures and storage conditions of milk.

The patterns of colonization and antifungal susceptibility of Candida, isolated from preterm neonates in Khorramabad, South West of Iran

ObjectiveUsually, 7–20% of preterm neonates colonized by Candida species present invasive candidiasis. Candida albicans, and several non-albicans species cause invasive infection with C. albicans being the most dominant agent. In the last two decades, infection due to non-albicans have been increased dramatically due to their low sensitivity to antifungal drugs such as fluconazole. The aim of present study was to evaluate Candida colonization pattern and antifungal susceptibility among preterm neonates from Khorramabad, South west of Iran. Materials and methodsSamples were collected from 80 preterm neonates, cultured on CHROMagar Candida and incubated at 37°C. All recovered isolates were primarily screened based on classical methods and identified by PCR-RFLP targeting the ITS-rDNA regions. Antifungal susceptibility testing of all isolates was performed according to the CLSI method against amphotericin B, caspofungin, itraconazole, fluconazole and voriconazole. ResultsTotally 23 isolates of Candida species were recovered from 20 patients (female: male, 50:50) including, C. albicans (18), C. parapsilosis (2) and C. glabrata (1). Furthermore, the blood cultures from two patients were yielded C. albicans and C. parapsilosis so that patient with C. albicans died after five days. Generally, in this study, 9 (39.1%) isolates were resistant to amphotericin B including; 7 (30.4%) C. albicans and 2 (8.7%) C. parapsilosis. In addition, 2 (8.7%) and 4 (17.4%) isolates were also resistant to itraconazole and caspofungin, respectively. ConclusionIn conclusion, Candida colonization among preterm neonates is still an important issue in hospitals. In addition, in spite of a significant amphotericin B resistant Candida, voriconazole, fluconazole, and itraconazole are valuable antifungals, due to fully sensitivity to Candida.

Candidal Species Identification in Malignant and Potentially Malignant Oral Lesions with Antifungal Resistance Patterns.

Objective:Candidal species identification in malignant and potentially malignant oral lesions with antifungal susceptibility.Materials and Methods:Oral candidal carriage, strain diversity, and antifungal susceptibility of Candida were checked for the patients having oral cancer or precancer reporting to the clinics for 1½ year. Statistically significant patients were selected and a control group was taken. A total of 105 individuals were selected and divided into three different groups. Salivary samples were taken from all the individuals. Candida detection was done using Sabouraud's agar and candidal species detection on CHROMagar. In vitro antifungal sensitivity was done using antifungal disc diffusion method.Results:Candida was isolated from 88.6% of patients with oral cancer and 45.7% in oral precancerous group. C. albicans was the predominant species found in 100% of oral precancerous and 71% in oral cancerous patients. Other Candid a species found were C. tropicalis (9.7%) and C. krusei (19.6%). Antifungal susceptibility showed 4.3% sensitivity to fluconazole and 100% sensitivity to amphotericin B and nystatin.Conclusion:Oral Candida carriage was higher in oral cancerous group and majority of them were sensitive to amphotericin B and nystatin.

Variability in the clinical distributions of Candida species and the emergence of azole-resistant non-Candida albicans species in public hospitals in the Midwest region of Brazil.

Incidence and antifungal susceptibility of Candida spp. from two teaching public hospitals are described. The minimum inhibitory concentrations of fluconazole, voriconazole, itraconazole, and amphotericin B were determined using Clinical Laboratory Standard Institute broth microdilution and genomic differentiation using PCR. Of 221 Candida isolates, 50.2% were obtained from intensive care unit patients; 71.5% were recovered from urine and 9.1% from bloodstream samples. Candida parapsilosis sensu stricto was the most common candidemia agent. We observed variations in Candida species distribution in hospitals in the same geographic region and documented the emergence of non-C. albicans species resistant to azoles.

Prevalence, virulence factors and antifungal susceptibility of Candida spp. isolated from bloodstream infections in a tertiary care hospital in Brazil.

Candida spp. are responsible for 80% of all systemic fungal infections and are associated with high mortality rates. This study characterised 79 bloodstream isolates of C. albicans, C. glabrata, C. orthopsilosis, C. parapsilosis and C. tropicalis from patients in a Brazilian hospital. The susceptibility to amphotericin B, caspofungin, fluconazole and voriconazole was determined; virulence factor production was assessed based on haemolysin, phospholipase and proteinase activities, and the patients' clinical characteristics were analysed. C. albicans was the predominant species (44%), followed by C. glabrata (19%), C. tropicalis (19%), C. parapsilosis (14%) and C. orthopsilosis (4%). The candidemia incidence was 1.52 per 1000 admissions, and the crude mortality rate was 52%. One C. albicans isolate was resistant to fluconazole and voriconazole. Moreover, 20.2%, 2.5% and 3.8% of the isolates exhibited dose-dependent susceptibility to fluconazole, voriconazole and caspofungin, respectively. In conclusion, although the C. glabrata incidence was higher than that usually described in Brazil, its increase was previously observed in studies conducted worldwide. Furthermore, the azole resistance of the C. albicans isolate could be due to previous exposure to these antifungals. These results highlight the importance of epidemiological studies and will facilitate an improved understanding of candidemia in the studied hospital.

Effect of essential oils from Mangifera indica L. cultivars on the antifungal susceptibility of Candida spp. strains isolated from dogs

SUMMARY This work reports the chemical study, and anti-Candida spp. activity of leaf essential oil from Mangifera indica cultivars. The essential oils were obtained by hydro-distillation and analyzed by gas chromatography/mass spectroscopy. The anti-Candida spp. activity was evaluated against strains isolated from dogs by the agar-well diffusion method and the minimum inhibitory concentration (MIC) by the broth microdilution method. Tommy Atkins cultivar presented β–selinene (29.49%), caryophyllene oxide (12.40%) and humulene II epoxide (8.66%) as main constituents, while the main constituents of Rosa, Moscatel and Jasmim varieties were caryophyllene oxide (23.62, 48.42 and 30.77%, respectively) and humulene epoxide II (11.56, 23.45, and16.27%, respectively). The means of inhibition zones were 11 ± 0.71, 13.5 ± 3.54, 10.5 ± 0.71 and 13.5 ± 0.71mm to Tommy Atkins, Rosa, Moscatel and Jasmim varieties, respectively. For Tommy Atkins, the MIC ranged from 0.62 to 1.25 mg/mL; for Rosa, ranged from 0.31 to 1.25 mg/mL; for Jasmim ranged from 0.31 to 0.62 mg/mL; while for the Moscatel variety the MIC value was 1.25 mg/mL for all Candida strains. Essential oils of four M. indica cultivars were active in vitro against Candida spp., demonstrating good antifungal activity and can be a useful source of antifungal compounds for veterinary medicine.

Distribution and Antifungal Susceptibility ofCandida Species Isolated from Clinical Specimens at the University Teaching Hospital, Lusaka, Zambia

Distribution and Antifungal Susceptibility ofCandida Species Isolated from Clinical Specimens at the University Teaching Hospital, Lusaka, Zambia

Salivary glucose levels, oral candidal carriage, candidal strain diversity and antifungal susceptibility of candida among adult diabetic patients

Salivary glucose levels, oral candidal carriage, candidal strain diversity and antifungal susceptibility of candida among adult diabetic patients

Investigation of ERG11 gene expression among fluconazole-resistant Candida albicans: first report from an Iranian referral paediatric hospital

ABSTRACTThe multiplicity of mechanisms of resistance to azole antifungal agents has been described. As fluconazole- resistant clinical Candida albicans isolates that constitutively over-express ERG11 have been identified in previous studies, the aim of this study is to investigate this molecular mechanism involved in fluconazole resistance of C. albicans clinical isolates. Fluconazole susceptibility testing was carried out on clinical isolates of Candida spp. obtained from hospitalised children in an Iranian referral children's hospital. A polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP) technique was used to differentiate Candida spp. The resistant C. albicans isolates were subjected to RT-qPCR using primers that identify ERG11 gene expression. Of the 142 Candida spp. isolates studied, C. albicans was the most predominant isolate, occurring in 68.3% (97/142) of the patients. According to the CLSI method, the majority of the C. albicans isolates (91.7%, 89/97), categorised as susceptible (minimum inhibitory concentration [MIC] ≤8 μg/mL), five isolates were considered resistant (MIC ≥64 μg/mL) and three had dose-dependent susceptibility (MIC=8.16–32 μg/mL). The ERG11 gene in the five fluconazole-resistant C. albicans isolates was upregulated 4.15–5.84-fold relative to the ATCC 10231 control strain. In this study, the expression of ERG11 was upregulated in all the fluconazole-resistant C. albicans isolates. There are limited data on the antifungal susceptibility of Candida spp. as well as the molecular mechanism of azole resistance in Iran, especially for isolates causing infections in children. Therefore, the surveillance of antifungal resistance patterns and investigation of other mechanisms of azole resistance in all Candida spp. isolates is recommended.

Species distribution and antifungal susceptibility of Candida spp. isolated from superficial candidiasis in outpatients in Iran

Candidiasis is the most prevalent fungal infection affecting human and animals all over the world. This study represents the epidemiological aspects of superficial candidiasis in outpatients and in vitro antifungal susceptibility of etiologic Candida species. Clinical samples were taken from 173 patients including skin and nail scrapings (107; 61.8%), vaginal discharge (28; 16.2%), sputum (20; 11.6%), oral swabs (7; 4.0%), bronchoalveolar lavage (6; 3.5%) and 1 specimen (0.6%) of each eye tumor, gastric juice, urine, biopsy and urinary catheter and confirmed as candidiasis by direct microscopy, culture and histopathology. Susceptibility patterns of the isolated Candida species were determined using the disk diffusion and broth microdilution methods. Among 173 Candida isolates, C. albicans (72.3%) was the most prevalent species followed by C. parapsilosis (11.5%). Other identified species were C. glabrata, C. krusei, C. tropicalis, C. guilliermondii, C. intermedia and C. sake. Majority of the Candida isolates were susceptible to fluconazole (95.4%) followed by 5-flucytosine (89.6%), voriconazole (78.6%) itraconazole (48.0%) and ketoconazole (42.8%). Caspofungin was the most potent antifungal drug against C. albicans (MICs; 0.062-1 μg/mL), ketoconazole for C. parapsilosis and C. tropicalis (MICs; 0.031-0.25 μg/mL) and itraconazole for C. krusei, C. glabrata and C. guilliermondii (MICs; 0.031-1 μg/mL). This study reinforces the significance of superficial candidiasis as an important fungal infection with multiple clinical presentations. Our results further indicate that susceptibility testing to commonly used antifungals is crucial in order to select the appropriate therapeutic strategies which minimize complications while improving patients' life.

Genetic diversity and antifungal susceptibility ofCandida zeylanoidesstrains obtained from the genital tract of female camels (Camelus dromedarius)

Genetic diversity and antifungal susceptibility of<i>Candida zeylanoides</i>strains obtained from the genital tract of female camels (<i>Camelus dromedarius</i>)

Evaluation of Antifungal Susceptibility Testing with Microdilution and Etest Methods of Candida Blood Isolates

Candida species that show an increasing number of clinical and/or microbiological resistance to several antifungals and are the most common agents of invasive fungal infections. The aim of this study was to investigate the in vitro susceptibility of Candida blood isolates to antifungal agents (amphotericin B, fluconazole, itraconazole, and voriconazole) by comparative use of the CLSI reference microdilution method and Etest. Four hundred Candida blood isolates (215 Candida albicans, 185 non-albicans Candida strains) were included in the study. The broth microdilution test was performed according to the CLSI M27 A2 document. Etest was carried out according to the manufacturer's instructions. The MIC results obtained with reference microdilution were compared with those obtained with the Etest by using percent and categorical agreements. According to MIK(90) values, voriconazole was the most active and itraconazole was the least active drug in vitro against all Candida species. Other than voriconazole, statistically significant differences were found when the susceptibility of Candida albicans and non-albicans Candida spp. to amphotericin B, fluconazole, and itraconazole were compared. These antifungal agents were found to be more active to C. albicans. Among the non-albicans Candida species, the lowest MIC values were obtained for Candida parapsilosis isolates. When the standard method was compared with Etest, the total agreement was higher for C. albicans than for non-albicans species, especially for fluconazole and voriconazole. In view of the findings, it was concluded that itraconazole showed the lowest activity against all Candida species. Etest could be an alternative method in assessing the in vitro antifungal susceptibility of Candida spp., but it is more convenient to use the microdilution method for studying in vitro susceptibility of non-albicans species, in particular for those possessing high MIC values against azoles.