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Vol.4 , No. 4, Publication Date: Aug. 25, 2017, Page: 44-50
| [1] | Imdat Kilbas, Department of Medical Microbiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey. |
| [2] | Ihsan Hakkı Ciftci, Department of Medical Microbiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey. |
Aim of the study: The frequency of antifungal resistance continues to increase, complicating patient management despite the introduction of new antifungal agents. Candida albicans is a pathogenic species that is most commonly isolated from patients with fungal infections. Material and Methods: In this meta-analysis, we evaluated the trends in C. albicans antifungal resistance over the past 15 years. The study was planned and conducted in accordance with the declaration of PRISMA and involved a literature search, determination of inclusion criteria for, and evaluation of articles, data collection and statistical analysis. Appropriate articles were searched for in Google Scholar, Science Direct, PubMed, and Web of Science. The data obtained from the literature were assessed according to inclusion and/or exclusion criteria. Following application of appropriate criteria, a meta-analysis of 23 studies published between 2000 and 2015 was performed. Results: The highest rate of resistance was determined against antifungals of the triazole group. The highest mean rates of resistance to itraconazole, voriconazole and econazole were 23.2±33.1%, 14.6±26.3% and 12.7±11.6% respectively. Among the triazole antifungals, the rate of resistance to fluconazole was found low with 9.6±17.8%. No resistance to caspofungin was detected. We found no report regarding susceptibility or resistance to imidazole derivatives in Turkey published in the last 10 years. Therefore, our comments about imidazole derivatives refer only to 2000 to 2005. The mean rates of resistance to antifungals differed significantly both with time and geographically. The highest mean rate of antifungal resistance was detected between 2011 and 2015. Eastern Anatolia showed a higher mean rate of resistance to antifungals compared to Western Anatolia and Central Anatolia. Using a random-effects model, the event rates of resistance to amphotericin B, nystatin, itraconazole, fluconazole, voriconazole, econazole, miconazole, and ketoconazole were 1.6%, 8.5%, 16.8%, 5.9%, 8.8%, 10.2%, 7.2%, and 4.1%respectively. The event rates for resistance to flucytosine and caspofungin were calculated using a fixed-effects model because their I2 values were <50. The event rates for resistance to flucytosine and caspofungin were determined as 0.9% and 0.6%, respectively. Conclusion: To our knowledge, this study is the first meta-analysis of the resistance to antifungal agents of clinical C. albicans isolates. This study could enhance our knowledge of the antifungal resistance of C. albicans but its renovation will continue in the future. Further research about C. albicans should be planned in detail, and focused on antifungal resistance, the quality of life of immune-suppressed patients, and treatment costs.
Keywords
Candida albicans, Antifungal Resistance, Meta-Analysis, TURKEY
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