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Local, systemic, demographic, and health-related factors influencing pathogenic yeast spectrum and antifungal drug administration frequency in oral candidiasis: a retrospective study

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Abstract

Objectives

In order to identify oral candidiasis patients being at risk of carrying potentially drug-resistant Candida, the aim of the study was to detect local, systemic, demographic, and health-related factors influencing (I) yeast spectrum composition and (II) antifungal administration frequency. Additionally, the aim was to investigate (III) species shift occurrence.

Materials and methods

Data from 798 patients (496 females, 302 males; mean age 59.7) with oral candidiasis diagnosed based on positive clinical and microbial findings (species identification and CFU count) between 2006 and 2011 were retrospectively analyzed using Pearson’s chi2 test and regression analysis.

Results

Among 958 isolates, Candida albicans was the most frequently detected (76.8 %). Also, species intrinsically resistant to azoles were frequently isolated (15.8 and 17.7 % of isolates and patients). (I) Infections only caused by C. albicans were significantly associated with the use of inhalation steroids (p = 0.001) and antibiotics (p = 0.04), super-infection of lichen planus (p = 0.002), and the absence of removable dentures (p < 0.001). (II) Anti-mycotics were significantly more frequently administered in patients using inhalation steroids (p = 0.001), suffering from asthma/COPD, or smoking heavily (p = 0.003) and if C. albicans and non-albicans species were detected together (p = 0.001). (III) Pathogen composition did not change over time within the examined period (p = 0.239).

Conclusions

Different variables enhance the presence of certain Candida and the antifungal prescription frequency. No species shift was evident.

Clinical relevance

The major pathogen in oral candidiasis remains C. albicans. Nevertheless, therapeutic problems may be caused by the frequent presence of species intrinsically resistant to azoles, especially in patients wearing dentures.

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Acknowledgments

The authors thank Dr. Konrad Neumann (Charité Centre 4, Institute of Medical Biometrics and Clinical Epidemiology, Charité Medical University, Berlin, Germany) for his most valuable support in performing statistical analysis.

Excerpts of the manuscript at hand were part of an oral presentation on the annual Meeting of the Association of Maxillofacial Surgery in Bad Homburg, Germany, on May 9th, 2013. With that exception, there is no overlap between the submission and any material, published or submitted.

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Authors and Affiliations

  1. Charité Centre 3, Department of Oral Medicine, Dental Radiology and Oral Surgery, Charité Universitätsmedizin Berlin, Aßmannshauser Str. 4, 14197, Berlin, Germany

    Moritz Hertel, Andrea Maria Schmidt-Westhausen & Frank-Peter Strietzel

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  1. Moritz Hertel
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  2. Andrea Maria Schmidt-Westhausen
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Correspondence to Moritz Hertel.

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This article does not contain any studies with human participants or animals performed by any of the authors. All procedures retrospectively using data from humans were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Formal approval was granted by the institutional ethical review committee of the Charité Universitätsmedizin Berlin (EA4/108/14). Data collected were pseudonymized at the stage of extraction from the patient’s charts. Only data assessed at our department within the regular treatment and diagnostic protocols were used.

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Hertel, M., Schmidt-Westhausen, A.M. & Strietzel, FP. Local, systemic, demographic, and health-related factors influencing pathogenic yeast spectrum and antifungal drug administration frequency in oral candidiasis: a retrospective study. Clin Oral Invest 20, 1477–1486 (2016). https://doi.org/10.1007/s00784-015-1631-0

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