Superficial Candidiasis: Cluster Analysis of Species Distribution and Their Antifungal Susceptibility In Vitro.

BACKGROUND

Superficial candidiasis (SC) is widespread in humans worldwide. This study aimed to evaluate species distribution patterns and antifungal susceptibility through cluster analysis.

METHODS

A total of 180 Candida strains isolated from skin and nail samples of 1593 examined patients with suspected superficial fungal infection were identified by Matrix-assisted laser desorption in ionization-time of flight mass spectrometry (MALDI-TOF MS; Zybio EXS2600, China). Antifungal susceptibility was assessed using the commercial Integral System YEASTS Plus test (ISYPT; Liofilchem®, Italy). Agglomerative hierarchical cluster analysis was used to analyze species distribution and susceptibility.

RESULTS

Candida parapsilosis (44.4%) and C. albicans (40%) were the most prevalent causative agents of SC. Cluster analysis established two defined clusters. Cluster 1 (121 isolates) showed a statistically significant difference compared to Cluster 2 (54 isolates) in species distribution (C. albicans was dominant in the first and C. parapsilosis in the second cluster) as well as in susceptibility to ECN (p ≤ 0.001), KCA (p = 0.030), CLO (p ≤ 0.001), MCZ (p ≤ 0.001), ITZ (p ≤ 0.001), and FLU (p ≤ 0.006).

CONCLUSION

The fact that one-third of isolates exhibited low sensitivity to antifungals highlights the need for a new approach in SC treatment, emphasizing the importance of mycological analyses, including in vitro testing of antifungal effectiveness.