Antifungal Resistance of Clinical Candida albicans Isolates in Iran: A Systematic Review and Meta-Analysis

Firoozeh  Kermani; Mojtaba  Taghizadeh-Armaki; Seyed Abdollah  Hosseini; Nasrin  Amirrajab; Javad  Javidnia; Mahmoud Fami  Zaghrami; Tahereh  Shokohi

doi:10.18502/ijph.v52i2.11874

Firoozeh Kermani Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
Mojtaba Taghizadeh-Armaki Department of Medical Parasitology and Mycology, School of Medicine, Babol University of Medical Sciences, Babol, Iran
Seyed Abdollah Hosseini Toxoplasmosis Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
Nasrin Amirrajab Department of Laboratory Sciences‚ School of Allied Medical Sciences‚ Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Javad Javidnia Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
Mahmoud Fami Zaghrami Knowledge-Based Darui Daneshgar Zolang Respina Pharmaceutical Company, Sari, Iran
Tahereh Shokohi Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran

DOI: https://doi.org/10.18502/ijph.v52i2.11874

Keywords: Antifungal susceptibility; Multi-drug resistance; Candida albicans; Systematic review

Abstract

Background: The present systematic review aimed to investigate the drug susceptibility patterns of Iranian clinical Candida albicans isolates to antifungal drugs (azoles, polyenes, and echinocandins).

Methods: Six electronic databases including “PubMed,” “Scopus,” “Web of Science,” “IranDoc”, “SID”, and “Magiran” were searched from May 2000 to June 2021. The susceptibility of 6322 C. albicans strains from 19967 patients against 14 antifungal drugs was evaluated according to CLSI method.

Results: The pooled prevalence of antifungal resistance ranged from 0% to 26%. The lowest resistance levels among azoles were observed in luliconazole with a frequency of 0% and voriconazole of 3.94%.

Conclusion: Due to the emergence of multi-drug resistant C. albicans, rational drug prescription based on the antifungal stewardship strategy and therapeutic drug monitoring is warranted.