A cross-sectional study to determine Candida spp. Carriage in Libyan patients with type 2 diabetes

Abstract

The risk for Candida infections in patients with diabetes mellitus (DM) is three times higher than in the general population. Despite a DM prevalence of 15.8% reported in Libya (2024), the laboratory identification and susceptibility testing of fungal infections in patients with DM are not routinely performed. This cross-sectional study investigated the prevalence and antifungal drug resistance patterns of Candida species in the oral mucosa of Libyan patients with Type 2 DM. Oral samples were collected with a sterile cotton swab, and 182 Candida isolates were phenotypically identified using the API ID 32 C and VITEK 2 Compact systems. Isolates were screened for their susceptibility to fluconazole and five other antifungals using disk diffusion and VITEK AST-YS07 cards. Statistically significant associations were found between Candida carriage and clinical presentation (p = 0.032), denture wearing (p = 0.025) and sex (p = 0.012). Although Candida albicans was the predominant species isolated (37.4%), the majority of isolates comprised non-albicans Candida (NAC). Candida humicola and Candida dubliniensis coexisted with other Candida species. Most Candida species showed susceptibility or dose-dependent susceptibility (DDS) to fluconazole with low resistance to the other antifungal drugs. Candida glabrata, Candida guilliermondii and Candida krusei were resistant to fluconazole, and multidrug resistance was observed in some C. albicans, C. dubliniensis and C. krusei isolates. Candida membranifaciens and Candida parapsilosis showed either DDS or resistance to fluconazole. The emerging resistance to second-line antifungals requires the establishment of routine Candida identification and antifungal susceptibility testing to guide species-specific treatment.