High incidence of azole resistance among Candida albicans and C. glabrata isolates in Northeastern Iran

Document Type : Original Articles


1 Allergy Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

2 Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.



Background and Purpose: Resistance to antifungal drugs is increasing among Candida isolates from patients with vulvovaginal candidiasis (VVC). Lack of correct diagnosis of Candida causing VVC and the experimental use of antifungal drugs are the main causes of this resistance. This study aimed to determine the susceptibility of antifungal drugs against Candida species isolated from VVC in Northeastern Iran.
Materials and Methods: Among women suspected of VVC, 189 vaginal discharge
specimens were evaluated. Candida isolates detected by polymerase chain reaction
restriction fragment length polymorphism were examined by standard antifungal disk
diffusion susceptibility testing method for voriconazole, itraconazole, fluconazole, and
ketoconazole. The susceptibility pattern of these antifungals was reported as sensitive,
susceptible dose-dependent, and resistant. The results were evaluated by SPSS software and analyzed by Pearson chi-squared test.
Results: Among the vaginal specimens, 108 out of 189 Candida isolates were identified
as C. albicans, C. glabrata, C. kefyr, C. parapsilosis, and C. tropicalis. The susceptibility
rates of Candida isolates to voriconazole, ketoconazole, itraconazole, and fluconazole
were 92.6%, 90.7%, 68.5%, and 63.9%, respectively. Moreover, the resistance rates to
fluconazole, itraconazole, ketoconazole, and itraconazole were 15.7%, 8.3%, 1.9%, and
1.9%, respectively. The C. glabrata and C. albicans isolates were resistant to antifungal
discs among 93% and 20% of the specimens, respectively.
Conclusion: The C. glabrata and C. albicans species showed the highest resistance to
antifungal drugs. Furthermore, Candida isolates showed the highest sensitivity to
voriconazole and ketoconazole and the lowest sensitivity to fluconazole.