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Vulvovaginal candidiasis : species distribution, fluconazole resistance and drug efflux pump gene overexpression
Author(s) -
Zhang JieYu,
Liu JinHui,
Liu FaDi,
Xia YanHua,
Wang Jing,
Liu Xi,
Zhang ZhiQin,
Zhu Na,
YanYan ,
Ying Ying,
Huang XiaoTian
Publication year - 2014
Publication title -
mycoses
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.13
H-Index - 69
eISSN - 1439-0507
pISSN - 0933-7407
DOI - 10.1111/myc.12204
Subject(s) - fluconazole , efflux , candida albicans , microbiology and biotechnology , corpus albicans , biology , drug resistance , vaginitis , vulvovaginal candidiasis , candida krusei , candida glabrata , genetics , antifungal
Summary The increasing incidence of vulvovaginal candidiasis ( VVC ) and the emergence of fluconazole resistance are an indisputable fact. However, little information is available regarding the correlation between fluconazole resistance in vaginal Candida albicans and the expression of drug efflux pump genes. In this study, we investigated the species distribution, fluconazole susceptibility profiles and the mechanisms of fluconazole resistance in Candida strains. In total, 785 clinical Candida isolates were collected from patients with VVC . C. albicans was the most frequently isolated species ( n = 529) followed by C. glabrata ( n = 164) and C. krusei ( n = 57). Of all Candida isolates, 4.7% were resistant to fluconazole. We randomly selected 18 fluconazole‐resistant isolates of C. albicans to evaluate the expression of CDR 1, CDR 2, MDR 1 and FLU 1 genes. Compared with fluconazole‐susceptible C. albicans isolates, CDR 1 gene expression displayed 3.16‐fold relative increase, which was statistically significant. CDR 2, MDR 1 and FLU 1 overexpression was observed in several fluconazole‐resistant C. albicans isolates, but statistical significance was not achieved. These results demonstrate a high frequency of non‐ albicans species (32.6%); however, C. albicans is the most common Candida species implicated in vaginitis, and this strain displays considerable fluconazole resistance. Meanwhile, our study further indicates that fluconazole resistance in C. albicans may correlate with CDR 1 gene overexpression.