Abstract

Background:
Infections caused by Candida species, including Candida albicans and non-albicans Candida (NAC), have emerged as a significant global health challenge. This trend is driven by the increasing prevalence of immunocompromised populations and the rise of antifungal resistance, which complicates clinical management and increases morbidity.

Aim:
This study aimed to investigate the distribution of Candida spp. and evaluate their antifungal susceptibility profiles among patients in Misurata, Libya, to provide evidence-based data for optimizing therapeutic strategies.

Methods:
A prospective cross-sectional study was conducted between 2024–2025, analyzing 103 Candida-positive isolates from seven laboratories in Misurata region. Identification was performed using Gram staining, culture on Sabouraud’s Dextrose Agar, Yeast extract peptone dextrose, and Chromogenic Candida Agar. Antifungal susceptibility testing (AST) was performed according to CLSI M44-A guidelines using the disc diffusion method for Amphotericin B, Miconazole, Fluconazole, and Nystatin.

Results:
The study population comprised 25% males and 75% females, with the highest prevalence observed in the 21–40 years age group. NAC species predominated (70%), with Candida glabrata being the most frequent (25%), followed by Candida tropicalis (24%), Candida krusei (11%), and Candida auris (8%). Candida albicans accounted for 32 % of isolates. Mixed infections were noted in 3 cases [C. tropicalis with C. albicans (67%) and C. tropicalis with C. krusei (33%)]. Urine specimens showed the highest prevalence of infection (55%), followed by high vaginal swabs (16%) and sputum (11%). Miconazole and Nystatin demonstrated the highest antifungal activity, while Fluconazole and Amphotericin B were less effective, particularly against NAC spp.

Conclusion:
Candidiasis represents a significant opportunistic infection in Misurata, with NAC species exhibiting increased resistance. Rapid identification using chromogenic media facilitates timely species detection, and ongoing antifungal susceptibility surveillance is essential for guiding effective therapy and limiting the spread of resistance.

Key words: Antifungal resistance; C. albicans; Candidiasis; Non-albicans Candida; Species distribution.