GENOTYPE-BASED ANTIFUNGAL SUSCEPTIBILITY OF CANDIDA ALBICANS IN ICU PATIENTS AT A TERTIARY CARE SETTING

Background and Objective: Oral Candidiasis is one of the most common opportunistic infections of Candida albicans. Treatment of C. albicans is becoming a challenge due to the acquired resistance to antifungal drugs. Resistance to antifungal drugs may vary among the C. albicans genotypes. The objective of the study was to find the genotype-based antifungal susceptibility of C. albicans isolated from oral candidiasis of ICU patients. Methods: This cross-sectional study was conducted at Ayub Medical Complex and Khyber Medical University Peshawar, Pakistan. Sampling was done from ICU patients, and identification of Candida species was carried out by inoculating samples on Sabouraud’s and CHROM agar (Oxoid Germany), by incubation at 37oC for 48 hours. The pathogenicity of C. albicans was confirmed by the formation of a germ tube. The antifungal sensitivity of C. albicans was determined on Moller Hinton agar according to the CLSI 2022 guidelines. Sensitivity to Fluconazole, Voriconazole, Clotrimazole, Nystatin, Amphotericin, (Oxoid) was assessed by disk diffusion method. Furthermore, the genotype identification was done by PCR through amplification of 25SrDNA amplification using specific primers. Results: Out of 260 samples, 145 (55.5%) samples were of candida species. Among the positive samples prevalence of C. albicans was predominant at 111(76.5 %) followed by C. tropicalis 15(10.34%), C. kruzei 11(7.58%), and C. glabrata 8(5.5%) high incidence was reported in females (59.4%) compared to males (49.55%). The most susceptible age groups were 61-70 years (27%) and 1- 10 years (20.70%), while the lowest incident was reported in the age group 20-30 years (2.70%). Among C. albicans genotype-A was more prevalent 65(58.5%) followed by genotype-B 33(28.82%), and genotype-C 14(12.6%). Overall, high resistance was reported against Voriconazole (70.2%) followed by Miconazole (61.2%), and fluconazole (58.5%) while comparatively lowest resistance was reported against clotrimazole (31.53%). Nystatin and Amphotericin were found effective against oral candidiasis in ICU patients with a resistance of 9.9% and 11.71%, respectively. Genotype-A of C. albicans was found to be highly resistant to the azole group of antifungal drugs among all three genotypes. Conclusion: Candida infection is common among ICU patients, especially at extremes of ages due to immune-compromised status. Overall, resistance to the Azole group of drugs is very high, however, the polyene group of drugs was found to be effective. The prevalence of Genotype-A of C. albicans was predominant in ICU patients with high resistance to Azole antifungal drugs. Keywords: Azole antifungal drugs. C. albicans. Genotype, Oral candidiasis, Polyenes