Introduction:Candidal infections of the oral cavity are clinically problematic as patients with such infections are associated with high rates of morbidity. Managing these patients with antifungal agents is often difficult due to development of resistance or presence of naturally resistant Candida species.

Objectives: To understand the mycological ecology of patients attending Glasgow Dental Hospital and to determine the antifungal susceptibilities for oral candidal isolates to Fluconazole and Itraconazole. Collectively, this will help to improve the clinical management of this patient cohort.

Methods: All candidal isolates submitted to the regional diagnostic oral microbiology laboratory based at Glasgow Dental Hospital & School over the period of 2006-2007 were tested for susceptibilities using E-test and CLSI methodology against Fluconazole and Itraconazole.

Results: A total of 792 yeasts were identified, of which C. albicans was the predominant (80.5%), followed by C. glabrata (13.1%), C. tropicalis (1.26%), C. dubliniensis (0.08%) and several others species (5.06%), for example C. krusei, C. parapsilosis and C. guilliermondii. The most common specimen type submitted was an oral rinse (n=358). For C. albicans the MIC50 and MIC90 for Fluconazole was 1.0 and 2.0 mg/L, and for Itraconazole 0.023 and 0.125 mg/L, respectively. For C. glabrata the MIC50 and MIC90 were equal for both Fluconazole (256 mg/L) and for Itraconazole (32 mg/L).

Conclusion: Within oral specimens submitted to Glasgow Dental Hospital diagnostic microbiology laboratory C. albicans is the predominant oral yeast, which responds to treatment with azole antifungal agents. However, in agreement with other studies there is an increased prevalence of C. glabrata isolates that are inherently resistant to azole antifungal agents. These results highlight the importance in obtaining accurate diagnostic information from an oral microbiology laboratory for identification of resistant species, such as C. glabrata. This plays a critical role in the clinical management of oral candidosis in these individuals.

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