{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T16:20:12Z","timestamp":1791390012318,"version":"4.3.3"},"reference-count":53,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,11,30]],"date-time":"2025-11-30T00:00:00Z","timestamp":1764460800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,11,30]],"date-time":"2025-11-30T00:00:00Z","timestamp":1764460800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["MicrobiologyOpen"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    The rise in azole resistance among\n                    <jats:italic>Nakaseomyces glabratus<\/jats:italic>\n                    and\n                    <jats:italic>Pichia kudriavzevii<\/jats:italic>\n                    in recurrent vulvovaginal candidiasis presents a growing public health challenge. This study investigated the expression of antifungal resistance\u2010related genes (\n                    <jats:italic>ERG11<\/jats:italic>\n                    ,\n                    <jats:italic>CDR1<\/jats:italic>\n                    ,\n                    <jats:italic>CDR2<\/jats:italic>\n                    , and\n                    <jats:italic>MDR1<\/jats:italic>\n                    ) in clinical resistant (CR) and clinical and laboratory resistant (CLR) strains of these yeasts. Cervicovaginal samples from patients with recurrent infections were collected, microscopically examined, and cultured. Yeast species were identified phenotypically and genotypically, followed by drug sensitivity testing. Total RNA was extracted, reverse transcribed to complementary DNA, and real\u2010time polymerase chain reaction was used to quantify target gene expression, comparing results to drug\u2010sensitive controls. Non\u2010\n                    <jats:italic>Candida albicans<\/jats:italic>\n                    species constituted 29% (45 cases) of the isolates, with\n                    <jats:italic>N. glabratus<\/jats:italic>\n                    (68%) and\n                    <jats:italic>P. kudriavzevii<\/jats:italic>\n                    (17%) being the dominant species. Other species included\n                    <jats:italic>Candida parapsilosis, Meyerozyma guilliermondii<\/jats:italic>\n                    ,\n                    <jats:italic>Candida orthopsilosis<\/jats:italic>\n                    ,\n                    <jats:italic>Saccharomyces cerevisiae<\/jats:italic>\n                    , and\n                    <jats:italic>Rhodotorula mucilaginosa<\/jats:italic>\n                    . Coinfections with\n                    <jats:italic>P. kudriavzevii\/C. albicans<\/jats:italic>\n                    and\n                    <jats:italic>N. glabratus\/C. albicans<\/jats:italic>\n                    were also observed. Ketoconazole, itraconazole, and 5\u2010flucytosine demonstrated the best antifungal activity against most species. However, some\n                    <jats:italic>N. glabratus<\/jats:italic>\n                    isolates were resistant to miconazole, clotrimazole, and amphotericin B, while all\n                    <jats:italic>P. kudriavzevii<\/jats:italic>\n                    isolates resisted clotrimazole. Overexpression of the\n                    <jats:italic>CDR1<\/jats:italic>\n                    gene was noted in\n                    <jats:italic>N. glabratus<\/jats:italic>\n                    (CR, 21.53\u2009\u00b1\u20091.26; CLR, 84.96\u2009\u00b1\u20090.67), and the\n                    <jats:italic>ERG11<\/jats:italic>\n                    and\n                    <jats:italic>CDR1<\/jats:italic>\n                    genes in\n                    <jats:italic>P. kudriavzevii<\/jats:italic>\n                    (\n                    <jats:italic>ERG11<\/jats:italic>\n                    for CR, 28.56\u2009\u00b1\u20092.16;\n                    <jats:italic>CDR1<\/jats:italic>\n                    for CLR, 35.89\u2009\u00b1\u20090.35). These results indicate that even in cases where an isolate is classified as susceptible by drug susceptibility testing, elevated gene expression may persist, and treatment should not be discontinued.\n                  <\/jats:p>","DOI":"10.1002\/mbo3.70123","type":"journal-article","created":{"date-parts":[[2025,11,30]],"date-time":"2025-11-30T11:47:02Z","timestamp":1764503222000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Non\u2010\n                    <i>albicans Candida<\/i>\n                    in Vulvovaginal Candidiasis: Antifungal Resistance and Expression of\n                    <i>ERG11<\/i>\n                    ,\n                    <i>CDR1<\/i>\n                    ,\n                    <i>CDR2<\/i>\n                    , and\n                    <i>MDR1<\/i>\n                    Genes"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-8129-0007","authenticated-orcid":false,"given":"Fatemeh Zahra","family":"Ranjbar Golafshani","sequence":"first","affiliation":[{"name":"Parasitology and Medical Mycology Department, Faculty of Medicine Babol University of Medical Sciences Babol Iran"},{"name":"Infectious Diseases and Tropical Medicine Research Center, Health Research Institute Babol University of Medical Sciences Babol Iran"},{"name":"Student Research Committee Babol University of Medical Sciences Babol Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8200-1346","authenticated-orcid":false,"given":"Firoozeh","family":"Kermani","sequence":"additional","affiliation":[{"name":"Parasitology and Medical Mycology Department, Faculty of Medicine Babol University of Medical Sciences Babol Iran"},{"name":"Infectious Diseases and Tropical Medicine Research Center, Health Research Institute Babol University of Medical Sciences Babol Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7697-607X","authenticated-orcid":false,"given":"Soheila","family":"Abbaszadeh Godarzi","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology Department, Faculty of Medicine Babol University of Medical Sciences Babol Iran"},{"name":"Infertility and Reproductive Health Research Center, Health Research Institute, Rouhani Hospital Babol University of Medical Sciences Babol Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1300-8987","authenticated-orcid":false,"given":"Saeid","family":"Mahdavi Omran","sequence":"additional","affiliation":[{"name":"Parasitology and Medical Mycology Department, Faculty of Medicine Babol University of Medical Sciences Babol Iran"},{"name":"Infectious Diseases and Tropical Medicine Research Center, Health Research Institute Babol University of Medical Sciences Babol Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,30]]},"reference":[{"key":"e_1_2_13_2_1","article-title":"Efflux Pump Mediated Resistance to Fluconazole in Candida glabrata in Vulvovaginal Candidiasis Patients","author":"Abd\u2010Alrahman E. 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