In vitro Antifungal Susceptibility Profile of Clinical in Malaysia.

PURPOSE

This study aimed to determine the antifungal susceptibility pattern of clinical isolates in Malaysia.

PATIENTS AND METHODS

Eight clinical strains of the were received from various Malaysian hospitals from the year 2020 until 2024. The isolates were obtained from patients with clinical presentations suggestive of cutaneous fungal infection. Their identities were determined using microscopic, macroscopic and molecular methods, specifically internal transcribed spacer (ITS) sequencing. Next, the antifungal susceptibility of amphotericin B, itraconazole, fluconazole, voriconazole, ravuconazole, posaconazole, ketoconazole, isavuconazole, flucytosine and terbinafine against the were determined using broth microdilution method as outlined in the Clinical and Laboratory Standards Institute (CLSI) M38 guideline. The geometric means (GM) of minimum inhibitory concentration (MIC), MIC, and MIC were determined for each antifungal. Subsequently, the Kruskal-Wallis test was performed to determine the significant difference observed in the median MIC values between the different antifungal groups (azole, polyene, pyrimidine and allylamine) against the isolate. The significance value was set at <0.05.

RESULTS

The GM MIC, MIC and MIC of all tested antifungals except amphotericin B and fluconazole against the were ≤0.25 μg/mL. In contrast, amphotericin B and fluconazole exhibited higher MICs ranging from 2 to 16 μg/mL. Furthermore, the Kruskal-Wallis test revealed a significant difference in the median MIC values across all antifungals, with a -value of 4.94 × 10⁻.

CONCLUSION

In conclusion, all the isolates in this study were susceptible to pyrimidine, allylamine, and azoles, while showing intermediate susceptibility to fluconazole and notable resistance to amphotericin B. Additionally, itraconazole and terbinafine could be recommended as the first-line therapy option, which was supported by their demonstrated efficacy (MIC ≤0.03 μg/mL) and clinical improvement observed in this study.