Ibuprofen-mediated reversal of fluconazole resistance in clinical isolates of Candida.
BACKGROUND
In view of the increasing prevalence of invasive Candidiasis in today's health-care scenario and the emergence of fluconazole resistance among clinical isolates of Candida, we sought to determine if Ibuprofen could elicit a reversal of fluconazole resistance and thereby offer a potential therapeutic breakthrough in fluconazole-resistant Candidiasis.


METHODS
We selected 69 clinical isolates of Candida, which demonstrated an MIC of >32 μg/ml for fluconazole, and subjected them to broth microdilution in presence and absence of Ibuprofen.


RESULTS
Forty two of the 69 isolates (60.9%) demonstrated reversal of Fluconazole resistance with concomitant use of Ibuprofen. This was characterized by significant species-wise variation (p=0.00008), with all the C. albicans isolates and none of the C. glabrata isolates demonstrating such reversal. Only 22.2% and 37.7% of C. krusei and C. tropicalis isolates respectively showed Ibuprofen-mediated reversal of Fluconazole resistance.


CONCLUSIONS
Since Ibuprofen is a known efflux pump inhibitor, our findings hint at the possible mechanism of Fluconazole resistance in most of our Candida isolates and suggest a potential therapeutic alternative that could be useful in the majority of Fluconazole-resistant clinical isolates of Candida.
Senior Resident, Department of Microbiology, Govt. Medical College , Jammu, Jammu & Kashmir, India .
Monika
M
Sharma
Professor, Department of Microbiology, AIIMS Bhopal, Bhopal, India .
Debasis
D
Biswas
Associate Professor, Department of Microbiology, Himalayan Institute of Medical Sciences , Jolly Grant, Dehradun, India .
Aarti
A
Kotwal
Associate Professor, Department of Microbiology, Subharti Medical College , Meerut, Uttar Pradesh, India .
Bhaskar
B
Thakuria
Associate Professor, Department of Microbiology, Himalayan Institute of Medical Sciences , Jolly Grant, Dehradun, India .
Barnali
B
Kakati
Lab Technician, Department of Microbiology, Himalayan Institute of Medical Sciences , Jolly Grant, Dehradun, India .
Bhupendra Singh
BS
Chauhan
Lab Technician, Department of Microbiology, Himalayan Institute of Medical Sciences , Jolly Grant, Dehradun, India .
Abhishek
A
Patras
Antifungal treatment; Candida; Efflux pump; Fluconazole resistance; Ibuprofen