Changing pattern of antifungal drug resistance in a tertiary health-care facility – A cross-sectional study

Abstract

Background: Fungal infections remain a major source of morbidity and mortality, but treatment choices are restricted due to limited classes of antifungal agents. The emergence of antifungal drug resistance (AFDR) is a major concern. Understanding trend in the development of AFDR will facilitate the use of therapeutic strategies to overcome and prevent antifungal resistance. The primary objective of the present study was to find out the pattern of AFDR in laboratory-confirmed mycological culture isolates. Methodology: The record-based cross-sectional study was carried out to analyze all the mycological culture sensitivity reports during a period of 3 years. The data set included clinicodemographic parameters such as age, gender, provisional diagnosis, type of culture specimens, identified fungal isolate, and susceptibility pattern. The association between the selected parameters and the pattern of AFDR was found out by Pearson's Chi-squared test. Results: AFDR among the isolates was 22 (75.86%), 8 (61.54%), 25 (100%), and 7 (70%) during the period from 2019 to 2022. The rate of AFDR was 33.87% during the study period. Antifungal susceptibility testing showed a rising trend in fluconazole resistance from 2019 (27.2%) to 2022 (57.1%). AFDR was highest in the age group of 41–60 years (48.3%), in males (72.5%), in skin scrapings (40.3%), and in cases with a provisional diagnosis of deep mycosis (51.6% in deep mycosis vs. 46.7% in superficial mycosis). The association between age, type of clinical specimen, type of mycosis, and occurrence of AFDR was statistically significant (P ≤ 0.05). The most common fungal specimen isolated was Candida albicans whereas the highest prevalence of AFDR was observed among Candida glabrata. Conclusion: In all the clinical conditions (superficial and deep mycosis), resistance to fluconazole was the predominant type of AFDR. There was a rising trend in the resistance pattern to fluconazole which is one of the most commonly used antifungal agents.