Resistance of candida species isolated form differnt pathological lesions to azole derivatives

ABSTRACT

Over the last three decades a variety of drugs have been developed for treatment of candidal infections, of these azoles have achieved a great impact, but azole resistance have been recently implicated as a cause of treatment failure in patients with candidal infections. So, the aim of this study is to test resistance of candidal isolates of different clinical samples to azoles, and to test combined azole preparations to detect synergistic actions of such drugs when used topically or systematically. To achieve the aim, 123 clinically diagnosed cases of candidiasis were sampled, examined by DM, count culture and culture on SDA, the 90 yielded isolates were identified by rapid Candifast identification method. Azole resistance was tested by a resistogram microtube commercial method and also by YNB agar-azole diluted method for more accuracy. The tested azoles were Clotrimazole [CMZ], Ketoconazole [KTZ], Miconazole [MCZ], Econazole [ECZ], Itraconazole [ICZ], Tioconazole [TCZ] and Fluconazole [FCZ]. In addition to C. albicans, other Candida species now emerge as pathogens. Resistance to topically used and systemically used azoles is high. KTZ is the most effective one [16.7, 25.6 resistant strains by the 2 methods at 15.6 ug/ml]. Nearly 1/3 of strains were resistant to azoles used at 7.8 ug/ml concentrations. Many combined topical azoles showed synergistic effect while the only combination of systemically used azoles that showed synergism was KTZ+FCZ