title: Candida profiles and antifungal resistance evolution over a decade in Lebanon.
abstract: BACKGROUND
  Infection with and antifungal resistance of Candida species have been on the rise globally. Relevant data on these pathogens are relatively few in our region, including Lebanon, thus warranting this study.
  
  
  METHODS
  This retrospective study of Candida spp. profiles and their in vitro antifungal susceptibility was based on analysis requests for 186 Candida non-albicans and 61 C. albicans during three periods (2005-2007, 2009-2011, and 2012-2014) over the span of the last 10 years at the American University of Beirut Medical Center (AUBMC), a major tertiary care center in Lebanon. Identification of Candida was done using the API 20C AUX system, and the E-test was used to determine the minimum inhibitory concentrations (MICs) of antifungal agents.
  
  
  RESULTS
  Among the 1,300-1,500 Candida isolates recovered yearly, C. albicans rates decreased from 86% in 2005 to around 60% in 2014. Simultaneously, the non-albicans rates increased from 14% in 2005 to around 40% in 2014, revealing 11 species, the most frequent of which were C. tropicalis, C. glabrata, and C. parapsilosis. All these demonstrated high resistance (35%-79%) against itraconazole, but remained uniformly susceptible (100%) to amphotericin B. Though C. albicans and the other species maintained high susceptibility against fluconazole and voriconazole, their MIC90 showed an elevated trend over time, and C. glabrata had the highest resistance rates.
  
  
  CONCLUSIONS
  The observed rise in resistance among Candida spp. in Lebanon mandates the need for close surveillance and monitoring of antifungal drug resistance for both epidemiologic and treatment purposes.
authors.affiliation: American University of Beirut Medical Center, Beirut, Lebanon. garaj@aub.edu.lb.
authors.forename: George Farah
authors.initials: GF
authors.lastname: Araj
authors.forename: Rima George
authors.initials: RG
authors.lastname: Asmar
authors.forename: Aline Zakaria
authors.initials: AZ
authors.lastname: Avedissian
mesh_terms: D000935:Antifungal Agents / Q000494:pharmacology*; D002175:Candida / Q000145:classification* / Q000187:drug effects* / Q000302:isolation & purification; D002177:Candidiasis / Q000453:epidemiology / Q000382:microbiology*; D025141:Drug Resistance, Fungal; D006801:Humans; D007861:Lebanon / Q000453:epidemiology; D008826:Microbial Sensitivity Tests; D015995:Prevalence; D012189:Retrospective Studies
chemical_list: D000935:Antifungal Agents