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

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

Iran J Public Health. 2023 Feb;52(2):290-305. doi: 10.18502/ijph.v52i2.11874.

Authors

Firoozeh Kermani¹, Mojtaba Taghizadeh-Armaki², Seyed Abdollah Hosseini³, Nasrin Amirrajab⁴, Javad Javidnia⁵, Mahmoud Fami Zaghrami⁶, Tahereh Shokohi¹

Affiliations

¹ Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.
² Department of Medical Parasitology and Mycology, School of Medicine, Babol University of Medical Sciences, Babol, Iran.
³ Toxoplasmosis Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.
⁴ Department of Laboratory Sciences' School of Allied Medical Sciences' Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
⁵ Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran.
⁶ Knowledge-Based Darui Daneshgar Zolang Respina Pharmaceutical Company, Sari, Iran.

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 anti-fungal stewardship strategy and therapeutic drug monitoring is warranted.

Keywords: Antifungal susceptibility; Candida albicans; Multi-drug resistance.

Publication types

Review