Antifungal susceptibility and evaluation of CDR۱ geneexpression in fluconazole-resistant Candida albicans isolated fromvulvovaginitis

Background and Aim : Vulvovaginal candidiasis (VVC) is one of the most common superficialfungal infections, and studies show that about ۷۵% of women experience VVC at least once intheir lifetime. The objective of this study was to analyse the antifungal susceptibility and the roleof CDR۱ gene overexpression as a mechanism of fluconazole resistance in Candida albicansisolated from vulvovaginitis patients.Methods : The study was performed in ۷۸ women suspected of vulvovaginitis. Isolated Candidaalbicans were identified using the ITS-restriction fragment length polymorphism (ITS-RFLP)technique. Antifungal susceptibility testing was performed for fluconazole, amphotericin B,ketoconazole, and itraconazole according to the CLSI M۲۷-A۳ guideline. CDR۱ gene expressionwas conducted in fluconazole-resistant isolates using real-time PCR.Results : Itraconazole was the most effective drug with MIC۵۰=۰.۲۵ ?g/mL and amphotericinBwas the least effective drug with MIC۵۰=۱ ?g/mL against Candida albicans among four testedantifungals with MIC range between ۰.۰۳-۸ ?g/ml and ۰.۰۶-۸ ?g/ml, respectively. Twelve isolateswere resistant to fluconazole. The overexpression of CDR۱ in fluconazole-resistant isolates wasobserved in ۱.۶۸–۳۲.۸-fold compared to the control strain C. albicans ATCC ۱۰۲۳۱.Conclusion : In isolates with high MIC, CDR۱ gene expression was high. It seems that resistantisolates are increasing and drug susceptibility testing is necessary to choose the appropriate drugand prevent resistance.

کلیدواژه ها:

Candida albicans ، Vulvovaginal candidiasis ، CDR۱ gene expression ، Antifungalsusceptibility