title: Vulvovaginal candidiasis: species distribution, fluconazole resistance  and drug efflux pump gene overexpression.
abstract: The increasing incidence of vulvovaginal candidiasis (VVC) and the emergence of fluconazole resistance are an indisputable fact. However, little information is available regarding the correlation between fluconazole resistance in vaginal Candida albicans and the expression of drug efflux pump genes. In this study, we investigated the species distribution, fluconazole susceptibility profiles and the mechanisms of fluconazole resistance in Candida strains. In total, 785 clinical Candida isolates were collected from patients with VVC. C. albicans was the most frequently isolated species(n = 529) followed by C. glabrata (n = 164) and C. krusei (n = 57). Of all Candida isolates, 4.7% were resistant to fluconazole. We randomly selected 18 fluconazole resistant isolates of C. albicans to evaluate the expression of CDR1, CDR2, MDR1 and FLU1 genes. Compared with fluconazole-susceptible C. albicans isolates, CDR1 gene expression displayed 3.16-fold relative increase, which was statistically significant. CDR2, MDR1 and FLU1 overexpression was observed in several fluconazole-resistant C. albicans isolates, but statistical significance was not achieved. These results demonstrate a high frequency of non-albicans species (32.6%); however, C. albicans is the most common Candida species implicated in vaginitis, and this strain displays considerable fluconazole resistance. Meanwhile, our study further indicates that fluconazole resistance in C. albicans may correlate with CDR1 gene overexpression.
authors: Jie-Yu
authors: JY
authors: Zhang
authors: Jin-Hui
authors: JH
authors: Liu
authors: Fa-Di
authors: FD
authors: Liu
authors: Yan-Hua
authors: YH
authors: Xia
authors: Jing
authors: J
authors: Wang
authors: Xi
authors: X
authors: Liu
authors: Zhi-Qin
authors: ZQ
authors: Zhang
authors: Na
authors: N
authors: Zhu
authors: Yan-Yan
authors: Ying
authors: Y
authors: Ying
authors: Xiao-Tian
authors: XT
authors: Huang
mesh_terms: D018528:ATP-Binding Cassette Transporters / Q000235:genetics* / Q000378:metabolism; D000935:Antifungal Agents / Q000494:pharmacology*; D002175:Candida / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D002181:Candidiasis, Vulvovaginal / Q000188:drug therapy / Q000382:microbiology*; D025141:Drug Resistance, Fungal; D005260:Female; D015725:Fluconazole / Q000494:pharmacology*; D005656:Fungal Proteins / Q000235:genetics* / Q000378:metabolism; D015966:Gene Expression Regulation, Fungal; D006801:Humans
chemical_list: D018528:ATP-Binding Cassette Transporters; D000935:Antifungal Agents; D005656:Fungal Proteins; D015725:Fluconazole