Nakaseomyces glabratus drug resistance genes expression in vulvovaginal candidiasis: a systematic review.

Abstract

Background and purpose: Antifungal resistance in Nakaseomyces glabratus presents a notable obstacle in the management of vulvovaginitis. Comprehension of drug-resistance gene expression is fundamental in the development of efficacious treatment strategies. This systematic review endeavored to ascertain the existing knowledge regarding the expression of drug resistance genes in N. glabratus associated with vulvovaginal candidiasis by the amalgamation of published research findings.

Materials and methods: Under the PRISMA guidelines, a systematic review was conducted from January 2000 to December 2024, utilizing the articles from "Web of Sciences", "PubMed", and "Scopus". The search incorporated the terms C. glabrata complex (C. glabrata sensu stricto, C. nivariensis, C. bracarensis) in conjunction with drug resistance gene expression in N. glabratus and closely related species with vulvovaginal candidiasis. The review was restricted to publications in English. The data extraction process employed EndNote software (version 21.4), and a meticulous selection process was undertaken to identify relevant studies.

Results: Three eligible studies reported an increase in the expression of the CDR1 gene in fluconazole-resistant N. glabratus, suggesting the presence of efflux mechanisms that reduce drug accumulation. Another study found enhanced CDR1 expression in fluconazole-resistant C. nivariensis, indicating the existence of similar resistance mechanisms. The observed variations in gene expression profiles between N. glabratus and C. nivariensis underscore the presence of diverse resistance mechanisms.

Conclusion: Review of the previous studies showed that the CDR1 gene was the most important resistance gene and that this resistance is more evident in C. nivarensis, compared to N. glabratus.