Antifungal susceptibility testing of Candida isolates from PLHIV patients

Introduction- There is a growing prevalence of fungal infections among immunocompromised patients, and there is also a concerning rise in resistance to commonly used antifungal medications. As a result, antifungal drug susceptibility testing has become an invaluable tool for clinicians, specifically in the treatment of invasive fungal infections and cases where initial treatments have proven ineffective.
Methodology- We conducted an analysis of the antifungal drug susceptibility patterns of 62 Candida isolates derived from various infection sites in a cohort of 165 PLHIV patients using the broth macrodilution method.
Results- A high resistance was observed to azole group with highest being Fluconazole (27%) followed by Voriconazole (14.5%) and Itraconazole (12.9%). No resistance was recorded for Amphotericin B and Caspofungin.
Discussion- Our findings indicate a higher resistance to Fluconazole, specifically in non-albicans Candida (NAC) species compared to Candida albicans. The presence of cross-resistance between Fluconazole and voriconazole is a matter of concern. However, it is important to note that no instances of resistance were observed for both Amphotericin B and Caspofungin. Nevertheless, elevated minimum inhibitory concentrations (MICs) were noted for these antifungal agents.
Conclusion- Routinely performing antifungal susceptibility testing in laboratories is crucial due to the growing resistance among antifungals, especially in the azole group. This resistance has led to the emergence of highly resistant and more harmful non-albicans Candida species. Thanks to the availability of standardised automated and manual methods, conducting such tests has become more accessible. Therefore, we strongly recommend performing routine susceptibility testing in laboratories to ensure appropriate treatment decisions for patients.