Molecular Identification and Evaluation of Resistance to Antifungal Drugs in Candida Species Isolated From Diaper Rash of Neonates Publisher



Shirvani F ; Fattahi M ; Karimi A ; Armin S ; Fahimzad SA ; Tabatabaei SR ; Ghanaei RM ; Fallah F ; Firooz A ; Tabatabaee S ; Radfar M ; Kalani D ; Foroozan H ; Galoogah AF Show All Authors
Source: Health Science Reports Published:2026

Abstract

Background: Diaper dermatitis, also recognized as diaper rash, is one of the most frequent skin conditions in neonates. Materials and Methods: A total of 100 babies participated in the study. Eligibility included neonates aged 5–28 days and full-time diaper wearers. Participants were categorized into two groups: those who received systemic antibiotics for at least 1 week and those who did not, in order to assess the impact of antibiotic use on diaper rash. The antifungal susceptibility was determined based on the reference method M60 CLSI. Results: Among 100 specimens, 50 cases suffered from Candida infection. The Candida albicans (34, 68%) was reported as the most frequent species, followed by C. kefyer (10, 20%), C. tropicalis (4, 8%), and C. glabrata (2; 4%). Nystatin, posaconazole, voriconazole, amphotericin B, ketoconazole, and clotrimazole showed high activity against all species (Minimum Inhibitory Concentration ≤ 0.125 µg/mL). The resistance frequency of C. albicans to itraconazole and fluconazole was 65.5% and 12.7%, respectively (minimum inhibitory concentration ≥ 16 and minimum inhibitory concentration ≥ 64, respectively). The allele with the K143R and Y132F replacements displayed the strongest characterized combination effect, with 14-fold and 18-fold increased itraconazole and fluconazole MICs, respectively. Conclusion: The selection of itraconazole and fluconazole-resistant isolates of candida among pediatric population may be a concern because C. albicans can be involved in invasive infections. The treatment of recurrent invasive candidiasis, needing repeated course of fluconazole or itraconazole, could be a risk factor for selecting resistant isolates. In addition, as the liposomal amphotericin B is no more commercialized in our country, a higher drug selection pressure for azoles may be expected in the future. © 2026 The Author(s). Health Science Reports published by Wiley Periodicals LLC.