EMERGING ANTIFUNGAL RESISTANCE IN BIOFILM-FORMING CANDIDA SPECIES ISOLATED FROM MEDICAL DEVICES: A MOLECULAR CHARACTERIZATION STUDY

Abstract

Biofilm formation by Candida species is a significant factor contributing to antifungal resistance, leading to persistent infections and increased healthcare burden. Biofilms enhance the survival of Candida species on medical devices, complicating treatment and increasing the risk of systemic infections. This study aimed to isolate and molecularly characterize antifungal resistance profiling of biofilm-forming Candida species from medical devices used in tertiary care hospitals in Peshawar, Pakistan. Samples of 400 medical devices were collected from various sections of Lady Reading Hospital (LRH), Hayatabad Medical complex (HMC) and Khyber Teaching Hospital (KTH). The devices included urine catheters (19.5%), central venous catheters (8.75%), endotracheal tubes (11.75%), ventilator masks (13.75%), intrauterine devices (18%), dental implants (7%), and syringes/IV cannulas (6.5%). Identification of Candida species was based on differential growth on chromogenic agar, which allowed for differentiation based on colony pigment. Congo red agar assay was performed to assess biofilm formation. Molecular characterization by 18S rRNA analysis and phylogenetic trees were constructed. The most prevalent of the 16 isolated Candida species was Candida albicans (43.75%) followed by Candida glabrata (25%), Candida tropicalis (18.75%) and Candida krusei (12.5%); all the isolated strains were biofilm producers. Congo red agar assay confirmed the biofilm-forming potential of these isolates. FTIR spectroscopy revealed the presence of important groups in the biofilm matrix, including proteins, polysaccharides, lipids, and hydroxyl-containing compounds that are essential for biofilm stability. This study demonstrates the cellular and chemical challenges of biofilm formation in Candida species isolated from medical devices. The chromogenic agar assay was shown to be useful for organism identification, while the Congo red assay confirmed the potential for biofilm formation. These findings highlight the urgent need for antifungal strategies to combat biofilm-associated infections in clinical settings.