Antifungal Resistance Profile of Fungal Isolates from Fungal Rhinosinusitis Patients: A Study from Tertiary Care Hospital

Abstract

Objective Fungal rhinosinusitis is on the rise worldwide and it is endemic especially in North India. The main purpose of this study was to determine the antifungal resistance profile of fungal isolates from the cases of fungal rhinosinusitis.

Methods Antifungal susceptibility testing of isolated fungi to fluconazole, amphotericin B, itraconazole, and voriconazole was determined by standard CLSI broth microdilution method.

Results Sixty-eight fungal isolates of Aspergillus spp. (n = 49), Rhizopus spp. (n = 9), Candida spp. (n = 4), Penicillium spp. (n = 2), Mucor spp. (n = 2), Bipolaris spp. (n = 1), and Alternaria spp. (n = 1) were obtained from 60 different clinical samples as exudate from nasal mucosa (n = 28), allergic mucin (n = 8), nasal lavage (n = 2), tissue biopsy from nasal polyps (n = 14), and intraoperative nasal mucosa (n = 8). Of the 68 isolates, 75% were resistant to fluconazole, 13.23% were resistant to itraconazole, 2.94% to amphotericin B, and none were resistant to voriconazole. Aspergillus flavus (5%) was the only fungi found resistant to amphotericin B, while against itraconazole, A. flavus (7.5%) and A. niger (100%) were found resistant. All the isolates of A. flavus, A. fumigatus, A. niger, and Penicillium spp. were resistant to fluconazole.

Conclusion Although amphotericin B stills remains to be the most effective drug, more prospective studies are needed for the requirement of knowledge of the sensitivity pattern for optimal treatment and reduction in morbidity in the long run.

Keywords

antifungal resistance - fungal sinusitis - antifungal susceptibility

Authors' Contributions

L.S. contributed to study design and concept, data acquisition, data analysis, manuscript preparation, editing, and review. R.K. helped in study design and concept, data analysis, manuscript preparation, editing, and review. M.S.D. contributed to data analysis, manuscript preparation, editing, and review. A.G. was involved in data acquisition, manuscript preparation, editing, and review.

Ethical Approval

Ethical approval has been obtained from institute's IEC under the number F.No./11/IEC/MAMC/2011/232 dated: 25/10/2013.

Publication History

Received: 25 October 2022

Accepted: 16 January 2023

Article published online:
04 April 2023

• References

• 1 deShazo RD, O'Brien M, Chapin K, Soto-Aguilar M, Gardner L, Swain R. A new classification and diagnostic criteria for invasive fungal sinusitis. Arch Otolaryngol Head Neck Surg 1997; 123 (11) 1181-1188
• 2 Gupta AK, Bansal S, Rijuneeta, Gupta B. Invasive fungal sinusitis. Clin Rhinol An Int J 2012; 5 (02) 63-71
• 3 Jain R, Singhal SK, Singla N, Punia RS, Chander J. Mycological profile and antifungal susceptibility of fungal isolates from clinically suspected cases of fungal rhinosinusitis in a tertiary care hospital in North India. Mycopathologia 2015; 180 (1-2): 51-59
• 4 Khan S, Singhal S, Mathur T, Upadhyay DJ, Rattan A. Antifungal susceptibility testing method for resource constrained laboratories. Indian J Med Microbiol 2006; 24 (03) 171-176
• 5 Clinical and Laboratory Standards Institute. Reference Method for Broth Dilution Antifungal Susceptibility Testing of Yeasts; Approved Standard. 3rd ed.. CLSI document M27–A3. Wayne, PA: CLSI; 2008. . Accessed February 6, 2023, at: https://clsi.org/media/1461/m27a3_sample.pdf
• 6 Clinical and Laboratory Standards Institute. Reference method for broth dilution antifungal susceptibility testing of filamentous fungi; approved standard-second edition. CLSI document M38–A3. Wayne, PA: CLSI; 2008. . Accessed February 6, 2023, at: https://clsi.org/media/1455/m38a2_sample.pdf
• 7 Subcommittee on Antifungal Susceptibility Testing of the ESCMID European Committee for Antimicrobial Susceptibility Testing. EUCAST Technical Note on the method for the determination of broth dilution minimum inhibitory concentrations of antifungal agents for conidia-forming moulds. Clin Microbiol Infect 2008; 14 (10) 982-984 Erratum in: Clin Microbiol Infect. 2009;15(1):103
• 8 Pappas PG, Kontoyiannis DP, Perfect JR, Chiller TM. Real-time treatment guidelines: considerations during the Exserohilum rostratum outbreak in the United States. Antimicrob Agents Chemother 2013; 57 (04) 1573-1576
• 9 Badali H, de Hoog GS, Curfs-Breuker I, Klaassen CH, Meis JF. Use of amplified fragment length polymorphism to identify 42 Cladophialophora strains related to cerebral phaeohyphomycosis with in vitro antifungal susceptibility. J Clin Microbiol 2010; 48 (07) 2350-2356
• 10 Rudramurthy SM, Jatana M, Singh R, Chakrabarti A. In vitro antifungal activity of Indian liposomal amphotericin B against clinical isolates of emerging species of yeast and moulds, and its comparison with amphotericin B deoxycholate, voriconazole, itraconazole and fluconazole. Mycoses 2013; 56 (01) 39-46
• 11 Lass-Flörl C, Mayr A, Perkhofer S. et al. Activities of antifungal agents against yeasts and filamentous fungi: assessment according to the methodology of the European Committee on Antimicrobial Susceptibility Testing. Antimicrob Agents Chemother 2008; 52 (10) 3637-3641
• 12 Mammen MD, Sahni RD, Varghese GM, Rupa V. Clinical utility of antifungal susceptibility testing in patients with fungal rhinosinusitis. Indian J Med Microbiol 2021; 39 (03) 328-333
• 13 Jain S, Das S, Gupta N, Malik JN. Frequency of fungal isolation and antifungal susceptibility pattern of the fungal isolates from nasal polyps of chronic rhinosinusitis patients at a tertiary care centre in North India. Med Mycol 2013; 51 (02) 164-169