Study finds high levels of antimicrobial resistance among Candida species
In Pakistan, the fungus Candida is becoming increasingly resistant to antimicrobial drugs, according to an AKU study. That is a worrisome finding given that Candida infections can pose a serious threat to human health. Candida is a type of fungus that ordinarily lives on the skin and in various areas within the body without causing harm. But if it invades the blood or organs, it can cause severe and fatal infections. People with weakened immune systems and those who have had certain types of hospital procedures are most at risk of contracting invasive Candida infections.
AKU researchers examined 2,200 Candida strains collected from 2015 to 2021 from hospitalized patients in Pakistan. The average rate of resistance to fluconazole, a first-line treatment, was 8 percent in newborns, 23 percent in children and 36 percent in adults. That represents a sharp increase from resistance rates of 2.1 percent between 2006 and 2009 and 4.6 percent between 2010 and 2014. In the United States, about 7 percent of all Candida strains isolated from blood samples tested by the Centers for Disease Control and Prevention (CDC) are resistant to fluconazole.
For the first time in Pakistan, the researchers found fluconazole resistance in Candida albicans, Candida parapsilosis and Candida tropicalis. They also analyzed drug-resistant Candida strains to identify genetic mutations that may contribute to resistance. “The reasons for increased drug resistance are multifactorial, including limited capacity for fungal diagnosis, overuse of antifungals for patient management and misuse of antifungals as disinfectants,” said Professor Kausar Jabeen, the study’s principal investigator.
The study’s results demonstrate the need for continuous surveillance of antifungal resistance in Pakistan. They may inform treatment and prevention guidelines, as well as policy development. AKU is a leader in the field of fungal diagnostics in Pakistan, having previously benefitted from a capacity-building partnership with the CDC’s Myotic Diseases Branch. The University is currently collaborating with Northwestern University in the United States to build its capacity in the genomic surveillance of Candida species using whole genome sequencing.