Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Nov;26(11):6479-6489.
doi: 10.1007/s00784-022-04716-2. Epub 2022 Sep 27.

Resistance profiles to antifungal agents in Candida albicans isolated from human oral cavities: systematic review and meta-analysis

Sarah Quadros Santos Kessler  1 , Pauline Mastella Lang  2 , Tatiane Silva Dal-Pizzol  3 , Francisco Montagner  4
Affiliations
Meta-Analysis

Resistance profiles to antifungal agents in Candida albicans isolated from human oral cavities: systematic review and meta-analysis

Sarah Quadros Santos Kessler et al. Clin Oral Investig. 2022 Nov.

Abstract

Aim: To identify the antifungal susceptibility profile of Candida spp. isolated from the human oral cavity was assessed with meta-analyses of observational studies that collected samples from the oral cavity of human subjects.

Material and methods: Isolated Candida albicans tested by E-test®; disk diffusion test; microdilution and macrodilution; Sensititre YeastOne; and/or FungiTest. Search strategies were conducted on the MEDLINE, Embase, CINAHL, Dentistry, and Oral Sciences, Central, Scopus, and LILACS databases, and gray literature sources. Articles were initially screened by title and then their abstracts. Articles that met the conditions for inclusion were read in full, followed by data extraction. A descriptive analysis was conducted of each study, and the data were tabulated. A first meta-analysis was conducted to assess the resistance of antifungals regardless of systemic comorbidities. An additional stratified analysis was conducted by systemic comorbidity groups for the outcome "resistance" to the antifungals.

Results: When not grouping Candida albicans isolates by systemic conditions, the lowest resistance rates to the antifungals tested were observed for amphotericin B, nystatin, flucytosine, and caspofungin. In contrast, the highest resistance rates were observed for miconazole and econazole. There was a high degree of heterogeneity and low resistance in general in all analyses, except for the "several associated comorbidities" group, which had high resistance rates.

Conclusions: Clinical C. albicans isolates had low antifungal resistance.

Clinical relevance: The presence of concomitant systemic comorbidities appears to be an essential factor that should be considered when evaluating resistance to antifungals for oral isolates.

Keywords: Antifungal agent; Candidiasis; Meta-analysis; Oral candidosis; Susceptibility.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Search strategy adopted for the study, showing MeSH keywords and the terms for antifungal activity and resistance of Candida spp. from the oral cavities of human subjects
Fig. 2
Fig. 2
PRISMA diagram illustrating the search strategy employed to identify studies related to resistance to antifungals of C. albicans isolated from the oral cavities of humans
See this image and copyright information in PMC

References

    1. Terézhalmy GT, Huber MA. Oropharyngeal candidiasis: etiology, epidemiology, clinical manifestations, diagnosis, and treatment. Pract Periodontics Aesthet Dent. 2011;9(6):635–641; quiz 642. - PubMed
    1. Mayor AM, Gómez MA, Ríos-Olivares E, Hunter-Mellado RF (2008) AIDS defining neoplasms prevalence in a cohort of HIV infected patients, before and after highly active antiretroviral therapy. Ethn Dis 18:S2–189–94 - PMC - PubMed
    1. Zhang L-W, Fu J-Y, Hua H, Yan Z-M. Efficacy and safety of miconazole for oral candidiasis: a systematic review and meta-analysis. Oral Dis. 2016;22:185–195. doi: 10.1111/odi.12380. - DOI - PubMed
    1. Quindós G, Gil-Alonso S, Marcos-Arias C, et al. Therapeutic tools for oral candidiasis: current and new antifungal drugs. Med Oral Patol Oral Cir Bucal. 2019;24:e172–e180. doi: 10.4317/medoral.22978. - DOI - PMC - PubMed
    1. Pappas PG et al (2016) Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis 62(4):e1-50. 10.1093/cid/civ933 - PMC - PubMed

Substances