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

Abstract

Purpose 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.