Emerging azole resistance among Candida albicans from clinical sources in Nairobi, Kenya.

Abstract

In the recent years the number of serious opportunistic yeast infections, particularly in immunocompromised patients has increased significantly. The increased incidence of these infections has paralleled the emergence of HIV/AIDS pandemic that result in lowered resistance of the host. Azole antifungal agents has been extensively used in the management of these yeast infections.   Candida albicans  is one of the most frequently isolated yeasts in clinical laboratories and accounts for up to 80 % of the yeasts recovered from sites of infection. The study was set out to determine antifungal susceptibility of clinical isolates of  Candida albicans  and to establish the Minimum Inhibitory Concentrations (MIC) to Fluconazole, Clotrimazole, Nystatin and Amphotericin B. Laboratory based experiment were conducted at Mycology Laboratory, Kenya Medical Research Institute, Nairobi, Kenya. One hundred and thirty clinical isolates of  Candida albicans  were subjected to antifungal susceptibility testing. Susceptibility to Fluconazole, Clotrimazole, Nystatin and Amphotericin B was done using Broth Microdilution Technique with reference to Clinical laboratory Standard Institute (CLSI). The investigations  showed that 16/130 (12.3 %) of the  Candida albicans isolates were resistant (MIC ≥ 64 µg/ml) to fluconazole, 121/130 (93.1 %) of the isolates had an MIC ≤ 1 µg/ml to Amphotericin B. Of the isolates 51/130 (39.2 %) had MIC> 1 µg/ml to clotrimazole whereas 109/130 (83.8 %) of the isolates had MIC  ≤ 1 µg/ml to nystatin. The study showed elevated MICs among  Candida albicans isolates to  fluconazole and clotrimazole and calls for constant antifungal resistance surveillance especially in the context of fluconazole maintenance treatment for opportunistic infections in HIV/AIDS.