Analysis of the prevalence and sensitivity to antimycotic drugs of C. albicans strains in Bukovina during 2019–2023
DOI:
https://doi.org/10.14739/2310-1210.2025.2.318170Keywords:
Candida albicans, spreading, resistance, anti-fungal agents, polyenes, azoles, COVID-19 pandemicAbstract
The aim of this work was to study the prevalence of C. albicans strains among patients with inflammatory processes of various localization during 2019–2023 years and to analyze dynamics in the sensitivity of these isolates to antifungal drugs.
Materials and methods. The study examined 608 strains of C. albicans: 161 strains isolated from the vaginal mucosa, 170 isolates – from the oral mucosa and tonsils, and 276 strains isolated from feces. A chromogenic medium was used for primary culture isolation, identification, and differentiation of Candida ssp. The sensitivity of all isolated strains to antifungal drugs (nystatin, amphotericin B, fluconazole, voriconazole, itraconazole, clotrimazole, econazole, miconazole, ketoconazole) was determined by the disk diffusion method according to the 2017 recommendations of the Clinical and Laboratory Standards Institute (CLSI).
Results. The incidence of C. albicans isolation from all studied biotopes had been increasing until 2022, whereas the number of isolations was statistically significantly higher in 2020 year compared to that in 2019 year: for strains isolated from the oral mucosa tφ = 1.67, p < 0.05; for vaginal isolates tφ = 2.66, p < 0.01; for fecal tφ = 2.76, p < 0.01. A statistically significant decrease in the isolation of C. albicans from all analyzed biotopes was noted in 2023. The dynamics of the isolated C. albicans strain sensitivity was barely related to the biotope of pathogen isolation. Among all the strains studied, sensitivity to nystatin remained high throughout the entire observation period, while it decreased to amphotericin B in 2020 (statistically significantly for vaginal isolates, tφ = 2.73, p < 0.01). The sensitivity of C. albicans strains to fluconazole and voriconazole was almost unchanged and did not relate to the biotope of pathogen isolation. Susceptibility to itraconazole was higher among all the strains (statistically significantly when comparing the data of 2021 and 2022: for oral strains tφ = 7.63 (p < 0.001); for vaginal tφ = 4.85 (p < 0.001); for fecal tφ = 7.97 (p < 0.001). The susceptibility of isolated C. albicans strains to clotrimazole, econazole, and ketoconazole was sharply decreased in 2020 with the onset of the SARS-CoV-2 pandemic (COVID-19), statistically significantly in most cases, and gradually increased to pre-epidemic levels in the years that followed.
Conclusions. The increase in the incidence of C. albicans isolation in 2020–2022 can be considered a trend for the initial period of the COVID-19 pandemic. At the same time, a substantial decrease, often statistically significant, in the isolated strain sensitivity to clotrimazole, econazole, ketoconazole and a gradual increase in this indicator the following year have been detected. The highest and almost constant sensitivity of the studied C. albicans strains was to nystatin, voriconazole, fluconazole, and it was the lowest to miconazole. Changes in the sensitivity of C. albicans strains to antifungal drugs require constant monitoring of this parameter.
References
Radunovic M, Barac M, Kuzmanovic Pficer J, Pavlica D, Jovanovic A, Pucar A, et al. Antifungal Susceptibility of Candida albicans Isolated from Tongue and Subgingival Biofilm of Periodontitis Patients. Antibiotics (Basel). 2022;11(6):802. doi: https://doi.org/10.3390/antibiotics11060802
Basmaciyan L, Bon F, Paradis T, Lapaquette P, Dalle F. Candida Albicans Interactions With The Host: Crossing The Intestinal Epithelial Barrier. Tissue Barriers. 2019;7(2):1612661. doi: https://doi.org/10.1080/21688370.2019.1612661
Maraki S, Mavromanolaki VE, Stafylaki D, Nioti E, Hamilos G, Kasimati A. Epidemiology and antifungal susceptibility patterns of Candida isolates from Greek women with vulvovaginal candidiasis. Mycoses. 2019;62(8):692-7. doi: https://doi.org/10.1111/myc.12946
Chen H, Zhou X, Ren B, Cheng L. The regulation of hyphae growth in Candida albicans. Virulence. 2020;11(1):337-48. doi: https://doi.org/10.1080/21505594.2020.1748930
Carolus H, Pierson S, Lagrou K, Van Dijck P. Amphotericin B and Other Polyenes-Discovery, Clinical Use, Mode of Action and Drug Resistance. J Fungi (Basel). 2020;6(4):321. doi: https://doi.org/10.3390/jof6040321
Lee Y, Puumala E, Robbins N, Cowen LE. Antifungal Drug Resistance: Molecular Mechanisms in Candida albicans and Beyond. Chem Rev. 2021;121(6):3390-411. doi: https://doi.org/10.1021/acs.chemrev.0c00199
Dhasarathan P, AlSalhi MS, Devanesan S, Subbiah J, Ranjitsingh AJ, Binsalah M, et al. Drug resistance in Candida albicans isolates and related changes in the structural domain of Mdr1 protein. J Infect Public Health. 2021;14(12):1848-53. doi: https://doi.org/10.1016/j.jiph.2021.11.002
Rabaan AA, Sulaiman T, Al-Ahmed SH, Buhaliqah ZA, Buhaliqah AA, AlYuosof B, et al. Potential Strategies to Control the Risk of Antifungal Resistance in Humans: A Comprehensive Review. Antibiotics (Basel). 2023;12(3):608. doi: https://doi.org/10.3390/antibiotics12030608
Patel JB, Weinstein MP, Eliopoulos GM, Jenkins SG, Lewis II JS, Limbago B, et al. Performance Standards for Antimicrobial Susceptibility Testing. CLSI Supplement M100. 27th ed. Wayne, PA, USA: Clinical Laboratory Standards Institute; 2017.
Habibzadeh A, Lankarani KB, Farjam M, Akbari M, Kashani SM, Karimimoghadam Z, et al. Prevalence of Fungal Drug Resistance in COVID-19 Infection: a Global Meta-analysis. Curr Fungal Infect Rep. 2022;16(4):154-64. doi: https://doi.org/10.1007/s12281-022-00439-9
Müderris T, Kaya S, Bayindir Bilman F, Ozmen E, Peker BO, Aksoy Gokmen A, et al. Relationship between COVID-19 and antimicrobial resistance. Marmara Med J. 2023;36(3):312-8. doi: https://doi.org/10.5472/marumj.1367895
Rawson TM, Moore LS, Castro-Sanchez E, Charani E, Davies F, Satta G, et al. COVID-19 and the potential long-term impact on antimicrobial resistance. J Antimicrob Chemother. 2020;75(7):1681-4. doi: https://doi.org/10.1093/jac/dkaa194
Seyoum E, Bitew A, Mihret A. Distribution of Candida albicans and non-albicans Candida species isolated in different clinical samples and their in vitro antifungal suscetibity profile in Ethiopia. BMC Infect Dis. 2020;20(1):231. doi: https://doi.org/10.1186/s12879-020-4883-5
Pfaller MA, Carvalhaes CG, DeVries S, Rhomberg PR, Castanheira M. Impact of COVID-19 on the antifungal susceptibility profiles of isolates collected in a global surveillance program that monitors invasive fungal infections. Med Mycol. 2022;60:myac028. doi: https://doi.org/10.1093/mmy/myac028
Jabeen G, Naz SA, Rangel DE, Jabeen N, Shafique M, Yasmeen K. In-vitro evaluation of virulence markers and antifungal resistance of clinical Candida albicans strains isolated from Karachi, Pakistan. Fungal Biol. 2023;127(7-8):1241-9. doi: https://doi.org/10.1016/j.funbio.2023.04.003
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