In-vitro Susceptibility of Candida Pathogens Isolated From Clinical Specimens to Available Antifungal Agents in Nigeria

Aim: To characterize clinical isolates of Candida species from a tertiary hospital in South West Nigeria and also to determine their susceptibility to antifungal agents in order to guide in the course of empirical treatment of patients visiting hospitals in Nigeria.
Study Design: This was a cross sectional study.
Place and Duration of Study: Medical Microbiology and Parasitology Laboratory, LAUTECH Teaching Hospital, Osogbo, Nigeria. Study duration was Five (5) months.
Methods: One hundred and twenty-four Candida species obtained from various body sites were identified and speciated using conventional and analytical profile index (API) for Candida and the susceptibility to 5 antifungal agents was determined using disc and macrodilution methods.
Results: Highest number of Candida was obtained from urine, 44 (35.5%); followed by High Vaginal Swabs (HVS), 32 (25.8%) and blood, 20 (16.1%). Highest frequencies were obtained from C. Krusei and C. tropicalis, 32 (25.8%) each, followed by C. Albicans and C. pseudotropicalis, 24 (19.4%) each, and C. gulliermondii,12 (9.7%). Susceptibility to amphotericin B was the highest (74%),followed by itraconazole (52%) while least susceptibility was found in ketoconazole (19.0%).Strains of C. krusei and C. guilliermondii demonstrated 100% resistance to fluconazole and clotrimazole, respectively. MIC50 in most cases were greater than clinical break points and MIC90 values ranged between 16 and >64 µg/ml for all antifungal agents except amphotericin B, 0.5 to 1 μg/ml.
Conclusion: Majority of Candida isolates are resistant to azole drugs. Amphotericin B is a reasonable alternative drug for empirical treatment of candidiasis since routine drug susceptibility testing Candida does not exist yet in any hospital in Nigeria.