{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T01:43:24Z","timestamp":1772502204116,"version":"3.50.1"},"reference-count":99,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T00:00:00Z","timestamp":1756080000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Universidad San Francisco de Quito USFQ","award":["12260"],"award-info":[{"award-number":["12260"]}]},{"name":"Universidad San Francisco de Quito USFQ","award":["17357"],"award-info":[{"award-number":["17357"]}]},{"name":"Universidad San Francisco de Quito USFQ","award":["16801"],"award-info":[{"award-number":["16801"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>Candida albicans and Candida glabrata are key fungal pathogens linked to candidiasis, with rising concerns due to antifungal resistance and biofilm abilities. However, data from Latin America remains limited. This study assessed biofilm formation and antifungal susceptibility of vaginal Candida isolates from Ecuadorian women. Biofilm formation at 24 and 48 h was evaluated using biomass and CFU assays and the biofilm formation index. Antifungal resistance in planktonic cells and patient microbiota profiles were also analyzed. Biofilm assessment showed 57.14% of isolates were high biofilm formers, 33.33% intermediate, 4.76% low, and 4.76% non-formers. Planktonic susceptibility testing included fluconazole, voriconazole, posaconazole, caspofungin, anidulafungin, micafungin, flucytosine, and amphotericin B. Micafungin showed the lowest MBEC90 value among tested antifungals, with an average MIC of 0.15 \u00b5g\/mL, MBIC90 of 1.26 \u00b5g\/mL, and MBEC90 of 1.86 \u00b5g\/mL. Fluconazole followed with MIC, MBIC90, and MBEC90 values of 4.19, 63.33, and 66.59 \u00b5g\/mL. Flucytosine had the highest values (MIC = 11.36 \u00b5g\/mL; MBIC90 = 244.71 \u00b5g\/mL; MBEC90 = 245.33 \u00b5g\/mL). Both micafungin and flucytosine produced similar reductions in viable biofilm cells (1.44 log CFU), while fluconazole induced a slightly lower reduction of 1.39 log CFU. Findings suggest echinocandins may be effective against biofilm-forming Candida in this Ecuadorian population subset.<\/jats:p>","DOI":"10.3390\/jof11090620","type":"journal-article","created":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T06:26:31Z","timestamp":1756189591000},"page":"620","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Impact of Biofilm Formation by Vaginal Candida albicans and Candida glabrata Isolates and Their Antifungal Resistance: A Comprehensive Study in Ecuadorian Women"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-8623-5042","authenticated-orcid":false,"given":"Ariana Cecibel","family":"Cede\u00f1o-Pinargote","sequence":"first","affiliation":[{"name":"Laboratorio de Bacteriolog\u00eda, Instituto de Microbiolog\u00eda, Colegio de Ciencias Biol\u00f3gicas y Ambientales COCIBA, Universidad San Francisco de Quito (USFQ), Calle Diego de Robles y Pampite, Quito 170901, Ecuador"}]},{"given":"Nicol\u00e1s Renato","family":"Jara-Medina","sequence":"additional","affiliation":[{"name":"Laboratorio de Bacteriolog\u00eda, Instituto de Microbiolog\u00eda, Colegio de Ciencias Biol\u00f3gicas y Ambientales COCIBA, Universidad San Francisco de Quito (USFQ), Calle Diego de Robles y Pampite, Quito 170901, Ecuador"}]},{"given":"Carlos C.","family":"Pineda-Cabrera","sequence":"additional","affiliation":[{"name":"Laboratorio de Bacteriolog\u00eda, Instituto de Microbiolog\u00eda, Colegio de Ciencias Biol\u00f3gicas y Ambientales COCIBA, Universidad San Francisco de Quito (USFQ), Calle Diego de Robles y Pampite, Quito 170901, Ecuador"}]},{"given":"Dar\u00edo F.","family":"Cueva","sequence":"additional","affiliation":[{"name":"Laboratorio de Bacteriolog\u00eda, Instituto de Microbiolog\u00eda, Colegio de Ciencias Biol\u00f3gicas y Ambientales COCIBA, Universidad San Francisco de Quito (USFQ), Calle Diego de Robles y Pampite, Quito 170901, Ecuador"}]},{"given":"Mar\u00eda P.","family":"Erazo-Garcia","sequence":"additional","affiliation":[{"name":"Laboratorio de Bacteriolog\u00eda, Instituto de Microbiolog\u00eda, Colegio de Ciencias Biol\u00f3gicas y Ambientales COCIBA, Universidad San Francisco de Quito (USFQ), Calle Diego de Robles y Pampite, Quito 170901, Ecuador"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1377-0413","authenticated-orcid":false,"given":"Eduardo","family":"Tejera","sequence":"additional","affiliation":[{"name":"Grupo de Bioquimioinform\u00e1tica, Facultad de Ingenier\u00eda y Ciencias Agropecuarias Aplicadas, Universidad de Las Am\u00e9ricas (UDLA), De Los Colimes esq, Quito 170513, Ecuador"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5089-8723","authenticated-orcid":false,"given":"Ant\u00f3nio","family":"Machado","sequence":"additional","affiliation":[{"name":"Laboratorio de Bacteriolog\u00eda, Instituto de Microbiolog\u00eda, Colegio de Ciencias Biol\u00f3gicas y Ambientales COCIBA, Universidad San Francisco de Quito (USFQ), Calle Diego de Robles y Pampite, Quito 170901, Ecuador"},{"name":"Centro de Biotecnologia dos A\u00e7ores (CBA), Departamento de Biologia, Faculdade de Ci\u00eancias e Tecnologia, Universidade dos A\u00e7ores, 9500-321 Ponta Delgada, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"641","DOI":"10.4314\/ahs.v20i2.12","article-title":"Biofilm Formation of Candida spp. Isolated from the Vagina and Antibiofilm Activities of Lactic Acid Bacteria on the These Candida Isolates","volume":"20","author":"Er","year":"2020","journal-title":"Afr. Health Sci."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"681","DOI":"10.3109\/13693780802549594","article-title":"Biofilms of Non-Candida albicans Candida Species: Quantification, Structure and Matrix Composition","volume":"47","author":"Silva","year":"2009","journal-title":"Med. Mycol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Lopes, J.P., Stylianou, M., Nilsson, G., and Urban, C.F. (2015). Opportunistic Pathogen Candida albicans Elicits a Temporal Response in Primary Human Mast Cells. Sci. Rep., 5.","DOI":"10.1038\/srep12287"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1007\/s40588-023-00190-w","article-title":"The Role of Host and Fungal Factors in the Commensal-to-Pathogen Transition of Candida albicans","volume":"10","author":"Jacobsen","year":"2023","journal-title":"Curr. Clin. Microbiol. Rep."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"101008","DOI":"10.1016\/j.mycmed.2020.101008","article-title":"Mortality and Risk Factor Analysis for Candida Blood Stream Infection: A Three-Year Retrospective Study","volume":"30","author":"Muderris","year":"2020","journal-title":"J. Mycol. Med."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Alkharashi, N., Aljohani, S., Layqah, L., Masuadi, E., Baharoon, W., Al-Jahdali, H., and Baharoon, S. (2019). Candida Bloodstream Infection: Changing Pattern of Occurrence and Antifungal Susceptibility over 10 Years in a Tertiary Care Saudi Hospital. Can. J. Infect. Dis. Med. Microbiol., 2019.","DOI":"10.1155\/2019\/2015692"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Santos, G.C.d.O., Vasconcelos, C.C., Lopes, A.J.O., Cart\u00e1genes, M.d.S.d.S., Filho, A.K.D.B., do Nascimento, F.R.F., Ramos, R.M., Pires, E.R.R.B., de Andrade, M.S., and Rocha, F.M.G. (2018). Candida Infections and Therapeutic Strategies: Mechanisms of Action for Traditional and Alternative Agents. Front. Microbiol., 9.","DOI":"10.3389\/fmicb.2018.01351"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Pan, Y., Sun, Y., Chen, L., Cheng, Y., Jin, P., Zhang, W., Zheng, L., Liu, J., Zhou, T., and Xu, Z. (2023). Candida Causes Recurrent Vulvovaginal Candidiasis by Forming Morphologically Disparate Biofilms on the Human Vaginal Epithelium. Biofilm, 6.","DOI":"10.1016\/j.bioflm.2023.100162"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/S1473-3099(10)70218-8","article-title":"Emerging Opportunistic Yeast Infections","volume":"11","author":"Miceli","year":"2011","journal-title":"Lancet Infect. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1007\/s12281-012-0094-x","article-title":"Recent Taxonomic Developments with Candida and Other Opportunistic Yeasts","volume":"6","author":"Brandt","year":"2012","journal-title":"Curr. Fungal Infect. Rep."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Amann, V., Kissmann, A.-K., Firacative, C., and Rosenau, F. (2025). Biofilm-Associated Candidiasis: Pathogenesis, Prevalence, Challenges and Therapeutic Options. Pharmaceuticals, 18.","DOI":"10.3390\/ph18040460"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1016\/j.riam.2017.07.001","article-title":"A Study on Candida Biofilm Growth Characteristics and Its Susceptibility to Aureobasidin A","volume":"35","author":"Munusamy","year":"2018","journal-title":"Rev. Iberoam. Micol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"838","DOI":"10.1016\/j.cmi.2021.11.024","article-title":"In vivo Emergence of High-Level Resistance during Treatment Reveals the First Identified Mechanism of Amphotericin B Resistance in Candida auris","volume":"28","author":"Rybak","year":"2022","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Denning, D.W. (2024). Renaming Candida glabrata\u2014A Case of Taxonomic Purity over Clinical and Public Health Pragmatism. PLoS Pathog., 20.","DOI":"10.1371\/journal.ppat.1012055"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1111\/j.1439-0507.2011.02076.x","article-title":"Antifungal Susceptibility of Candida albicans in Biofilms","volume":"55","author":"Tobudic","year":"2012","journal-title":"Mycoses"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Atiencia-Carrera, M.B., Cabezas-Mera, F.S., Vizuete, K., Debut, A., Tejera, E., and Machado, A. (2022). Evaluation of the Biofilm Life Cycle between Candida albicans and Candida tropicalis. Front. Cell. Infect. Microbiol., 12.","DOI":"10.3389\/fcimb.2022.953168"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Cavalheiro, M., and Teixeira, M.C. (2018). Candida Biofilms: Threats, Challenges, and Promising Strategies. Front. Med., 5.","DOI":"10.3389\/fmed.2018.00028"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1007\/s11046-020-00445-w","article-title":"Candida Biofilms: An Update on Developmental Mechanisms and Therapeutic Challenges","volume":"185","author":"Rossoni","year":"2020","journal-title":"Mycopathologia"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Silva, S., Rodrigues, C.F., Ara\u00fajo, D., Rodrigues, M.E., and Henriques, M. (2017). Candida Species Biofilms\u2019 Antifungal Resistance. J. Fungi, 3.","DOI":"10.3390\/jof3010008"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1038\/nrmicro.2016.94","article-title":"Biofilms: An Emergent Form of Bacterial Life","volume":"14","author":"Flemming","year":"2016","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1128\/MMBR.00068-15","article-title":"Plasticity of Candida albicans Biofilms","volume":"80","author":"Soll","year":"2016","journal-title":"Microbiol. Mol. Biol. Rev."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Rodr\u00edguez-Cerdeira, C., Mart\u00ednez-Herrera, E., Carnero-Gregorio, M., L\u00f3pez-Barcenas, A., Fabbrocini, G., Fida, M., El-Samahy, M., and Gonz\u00e1lez-Cesp\u00f3n, J.L. (2020). Pathogenesis and Clinical Relevance of Candida Biofilms in Vulvovaginal Candidiasis. Front. Microbiol., 11.","DOI":"10.3389\/fmicb.2020.544480"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1016\/j.micinf.2009.04.018","article-title":"Biofilm Formation in Clinical Candida Isolates and Its Association with Virulence","volume":"11","author":"Hasan","year":"2009","journal-title":"Microbes. Infect."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e4317","DOI":"10.7717\/peerj.4317","article-title":"Bacterial Identification of the Vaginal Microbiota in Ecuadorian Pregnant Teenagers: An Exploratory Analysis","volume":"6","author":"Salinas","year":"2018","journal-title":"PeerJ"},{"key":"ref_25","first-page":"1","article-title":"Vaginal Microbiota Evaluation and Lactobacilli Quantification by QPCR in Pregnant and Non-Pregnant Women: A Pilot Study","volume":"10","author":"Vasco","year":"2020","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Pacha-Herrera, D., Erazo-Garcia, M.P., Cueva, D.F., Orellana, M., Borja-Serrano, P., Arboleda, C., Tejera, E., and Machado, A. (2022). Clustering Analysis of the Multi-Microbial Consortium by Lactobacillus Species Against Vaginal Dysbiosis Among Ecuadorian Women. Front. Cell. Infect. Microbiol., 12.","DOI":"10.3389\/fcimb.2022.863208"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Salinas, A.M., Osorio, V.G., Herrera, D.P., Vivanco, J.S., Trueba, A.F., and Machado, A. (2020). Vaginal Microbiota Evaluation and Prevalence of Key Pathogens in Ecuadorian Women: An Epidemiologic Analysis. Sci. Rep., 10.","DOI":"10.1038\/s41598-020-74655-z"},{"key":"ref_28","unstructured":"(2024, February 02). EUCAST European Committee on Antimicrobial Susceptibility Testing\u2014Clinical Breakpoints for Fungi (Candida and Aspergillus Species). Available online: https:\/\/www.eucast.org\/astoffungi\/clinicalbreakpointsforantifungals."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e00069-19","DOI":"10.1128\/CMR.00069-19","article-title":"Antifungal Susceptibility Testing: Current Approaches","volume":"33","author":"Berkow","year":"2020","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Fernandez-Soto, P., Celi, D., Tejera, E., Alvarez-Suarez, J.M., and Machado, A. (2023). Cinnamomum sp. and Pelargonium odoratissimum as the Main Contributors to the Antibacterial Activity of the Medicinal Drink Horchata: A Study Based on the Antibacterial and Chemical Analysis of 21 Plants. Molecules, 28.","DOI":"10.3390\/molecules28020693"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.1128\/JCM.02363-09","article-title":"Candida Surveillance Study Investigators Antifungal Susceptibility Testing of Candida Isolates from the Candida Surveillance Study","volume":"48","author":"Lyon","year":"2010","journal-title":"J. Clin. Microbiol."},{"key":"ref_32","first-page":"62","article-title":"Biofilm-Forming Capacity of Blood\u2013Borne Candida albicans Strains and Effects of Antifungal Agents","volume":"50","author":"Turan","year":"2018","journal-title":"Rev. Argent Microbiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"100543","DOI":"10.1016\/j.crfs.2023.100543","article-title":"Evaluation of the Polyphenolic Profile of Native Ecuadorian Stingless Bee Honeys (Tribe: Meliponini) and Their Antibiofilm Activity on Susceptible and Multidrug-Resistant Pathogens: An Exploratory Analysis","volume":"7","author":"Debut","year":"2023","journal-title":"Curr. Res. Food Sci."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Gulati, M., Lohse, M.B., Ennis, C.L., Gonzalez, R.E., Perry, A.M., Bapat, P., Arevalo, A.V., Rodriguez, D.L., and Nobile, C.J. (2018). In vitro Culturing and Screening of Candida albicans Biofilms. Curr. Protoc. Microbiol., 50.","DOI":"10.1002\/cpmc.60"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1909","DOI":"10.1038\/nprot.2008.192","article-title":"In vitro Growth and Analysis of Candida Biofilms","volume":"3","author":"Chandra","year":"2008","journal-title":"Nat. Protoc."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Cruz, C.D., Shah, S., and Tammela, P. (2018). Defining Conditions for Biofilm Inhibition and Eradication Assays for Gram-Positive Clinical Reference Strains. BMC Microbiol., 18.","DOI":"10.1186\/s12866-018-1321-6"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Thieme, L., Hartung, A., Tramm, K., Klinger-Strobel, M., Jandt, K.D., Makarewicz, O., and Pletz, M.W. (2019). MBEC Versus MBIC: The Lack of Differentiation between Biofilm Reducing and Inhibitory Effects as a Current Problem in Biofilm Methodology. Biol. Proced. Online, 21.","DOI":"10.1186\/s12575-019-0106-0"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"4181","DOI":"10.2147\/IDR.S373991","article-title":"Antibiofilm Activity of Essential Fatty Acids Against Candida albicans from Vulvovaginal Candidiasis and Bloodstream Infections","volume":"15","author":"Wang","year":"2022","journal-title":"Infect. Drug Resist."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.btre.2015.08.003","article-title":"Optimization of Single Plate-Serial Dilution Spotting (SP-SDS) with Sample Anchoring as an Assured Method for Bacterial and Yeast CFU Enumeration and Single Colony Isolation from Diverse Samples","volume":"8","author":"Thomas","year":"2015","journal-title":"Biotechnol. Rep."},{"key":"ref_40","unstructured":"IBM Corp (2021). IBM SPSS Statistics for Windows, IBM."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"4600","DOI":"10.1016\/j.physa.2009.07.015","article-title":"Fractal Protein Structure Revisited: Topological, Kinetic and Thermodynamic Relationships","volume":"388","author":"Tejera","year":"2009","journal-title":"Phys. A Stat. Mech. Its Appl."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"5045","DOI":"10.1016\/j.ejmech.2009.09.008","article-title":"Application of Desirability-Based Multi(Bi)-Objective Optimization in the Design of Selective Arylpiperazine Derivates for the 5-HT1A Serotonin Receptor","volume":"44","author":"Machado","year":"2009","journal-title":"Eur. J. Med. Chem."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Alomeir, N., Zeng, Y., Fadaak, A., Wu, T.T., Malmstrom, H., and Xiao, J. (2023). Effect of Nystatin on Candida albicans\u2014Streptococcus mutans Duo-Species Biofilms. Arch. Oral Biol., 145.","DOI":"10.1016\/j.archoralbio.2022.105582"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.1093\/mmy\/myab041","article-title":"Antifungal Susceptibility of Clinical Cryptococcus gattii Isolates from Colombia Varies among Molecular Types","volume":"59","author":"Firacative","year":"2021","journal-title":"Med. Mycol."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Feldman, M., Sionov, R.V., Mechoulam, R., and Steinberg, D. (2021). Anti-Biofilm Activity of Cannabidiol against Candida albicans. Microorganisms, 9.","DOI":"10.3390\/microorganisms9020441"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1146\/annurev-micro-091014-104330","article-title":"Candida albicans Biofilms and Human Disease","volume":"69","author":"Nobile","year":"2015","journal-title":"Annu. Rev. Microbiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"4","DOI":"10.4103\/0974-777X.77288","article-title":"Distribution of Candida Species in Different Clinical Samples and Their Virulence: Biofilm Formation, Proteinase and Phospholipase Production: A Study on Hospitalized Patients in Southern India","volume":"3","author":"Mohandas","year":"2011","journal-title":"J. Glob. Infect. Dis."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Hetta, H.F., Melhem, T., Aljohani, H.M., Salama, A., Ahmed, R., Elfadil, H., Alanazi, F.E., Ramadan, Y.N., Battah, B., and Rottura, M. (2025). Beyond Conventional Antifungals: Combating Resistance Through Novel Therapeutic Pathways. Pharmaceuticals, 18.","DOI":"10.3390\/ph18030364"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Marak, M.B., and Dhanashree, B. (2018). Antifungal Susceptibility and Biofilm Production of Candida spp. Isolated from Clinical Samples. Int. J. Microbiol., 10.","DOI":"10.1155\/2018\/7495218"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.ajog.2019.10.008","article-title":"Associations between the Vaginal Microbiome and Candida Colonization in Women of Reproductive Age","volume":"222","author":"Tortelli","year":"2020","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Rodr\u00edguez-Arias, R.J., Guachi-\u00c1lvarez, B.O., Montalvo-Vivero, D.E., and Machado, A. (2022). Lactobacilli Displacement and Candida albicans Inhibition on Initial Adhesion Assays: A Probiotic Analysis. BMC Res. Notes, 15.","DOI":"10.1186\/s13104-022-06114-z"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1128\/msystems.00622-21","article-title":"Recurrent Vulvovaginal Candidiasis: A Dynamic Interkingdom Biofilm Disease of Candida and Lactobacillus","volume":"6","author":"McKloud","year":"2021","journal-title":"mSystems"},{"key":"ref_53","first-page":"37","article-title":"Prevalence of Vulvovaginal Candidiasis among Nonpregnant Women Attending a Tertiary Health Care Facility in Abuja, Nigeria","volume":"6","author":"Uchenna","year":"2015","journal-title":"Res. Rep. Trop. Med."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"44","DOI":"10.9790\/0853-13524449","article-title":"Prevalence and Antifungal Susceptibility of Candida Species Isolated From Patients Attending Tertiary Care Hospital","volume":"13","author":"Sajjan","year":"2014","journal-title":"IOSR J. Dent. Med. Sci. (IOSR-JDMS)"},{"key":"ref_55","first-page":"122","article-title":"Incidence of Various Causes of Vaginal Discharge among Sexually Active Females in Age Group 20\u201340 Years","volume":"69","author":"Puri","year":"2003","journal-title":"Indian J. Dermatol. Venereol. Leprol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1007\/BF01719311","article-title":"Sexual Behavior of Women with Repeated Episodes of Vulvovaginal Candidiasis","volume":"11","author":"Hellberg","year":"1995","journal-title":"Eur. J. Epidemiol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1007\/s10123-018-0014-1","article-title":"The Continuous Changes in the Aetiology and Epidemiology of Invasive Candidiasis: From Familiar Candida albicans to Multiresistant Candida auris","volume":"21","author":"Mateo","year":"2018","journal-title":"Int. Microbiol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"ofaa270","DOI":"10.1093\/ofid\/ofaa270","article-title":"Impact of Infectious Disease Consultation in Patients with Candidemia: A Retrospective Study, Systematic Literature Review, and Meta-Analysis","volume":"7","author":"Kobayashi","year":"2020","journal-title":"Open Forum. Infect. Dis."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Sarpong, A.K., Odoi, H., Boakye, Y.D., Boamah, V.E., and Agyare, C. (2024). Resistant, C. albicans Implicated in Recurrent Vulvovaginal Candidiasis (RVVC) among Women in a Tertiary Healthcare Facility in Kumasi, Ghana. BMC Womens Health, 24.","DOI":"10.1186\/s12905-024-03217-6"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.1128\/AAC.05025-11","article-title":"Effect of PH on in vitro Susceptibility of Candida glabrata and Candida albicans to 11 Antifungal Agents and Implications for Clinical Use","volume":"56","author":"Danby","year":"2012","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1179\/joc.2008.20.4.488","article-title":"Emergence of Resistance to Amphotericin B and Triazoles in Candida glabrata Vaginal Isolates in a Case of Recurrent Vaginitis","volume":"20","author":"Khan","year":"2008","journal-title":"J. Chemother."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1966","DOI":"10.1111\/jcpt.13821","article-title":"Progress of Triazole Antifungal Agent Posaconazole in Individualized Therapy","volume":"47","author":"Shu","year":"2022","journal-title":"J. Clin. Pharm. Ther."},{"key":"ref_63","first-page":"994","article-title":"Comparative Effectiveness of Echinocandins vs Triazoles or Amphotericin B Formulations as Initial Directed Therapy for Invasive Candidiasis in Children and Adolescents","volume":"10","author":"Fisher","year":"2021","journal-title":"J. Pediatric Infect. Dis. Soc."},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Whaley, S.G., Berkow, E.L., Rybak, J.M., Nishimoto, A.T., Barker, K.S., and Rogers, P.D. (2017). Azole Antifungal Resistance in Candida albicans and Emerging Non-albicans Candida Species. Front. Microbiol., 7.","DOI":"10.3389\/fmicb.2016.02173"},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Espinel-Ingroff, A., Cant\u00f3n, E., and Pem\u00e1n, J. (2021). Antifungal Resistance among Less Prevalent Candida Non-albicans and Other Yeasts versus Established and under Development Agents: A Literature Review. J. Fungi., 7.","DOI":"10.3390\/jof7010024"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1128\/JCM.03044-13","article-title":"Impact of New Antifungal Breakpoints on Antifungal Resistance in Candida Species","volume":"52","author":"Fothergill","year":"2014","journal-title":"J. Clin. Microbiol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"915.e5","DOI":"10.1016\/j.cmi.2021.02.006","article-title":"In vitro Activity of Ibrexafungerp and Comparators against Candida albicans Genotypes from Vaginal Samples and Blood Cultures","volume":"27","author":"Mesquida","year":"2021","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Mart\u00ednez-Herrera, E., Fr\u00edas-De-Le\u00f3n, M.G., Hern\u00e1ndez-Castro, R., Garc\u00eda-Salazar, E., Arenas, R., Ocharan-Hern\u00e1ndez, E., and Rodr\u00edguez-Cerdeira, C. (2021). Antifungal Resistance in Clinical Isolates of Candida glabrata in Ibero-America. J. Fungi, 8.","DOI":"10.3390\/jof8010014"},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Galia, L., Pezzani, M.D., Compri, M., Callegari, A., Rajendran, N.B., Carrara, E., and Tacconelli, E. (2022). Surveillance of Antifungal Resistance in Candidemia Fails to Inform Antifungal Stewardship in European Countries. J. Fungi, 8.","DOI":"10.3390\/jof8030249"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1128\/AAC.02265-15","article-title":"Acquired Flucytosine Resistance during Combination Therapy with Caspofungin and Flucytosine for Candida glabrata Cystitis","volume":"60","author":"Charlier","year":"2016","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1080\/12298093.2025.2461336","article-title":"Trends in Candida albicans Bloodstream Infections and Antifungal Resistance in a Tertiary Care Hospital in South Korea (2013\u20132023)","volume":"53","author":"Kim","year":"2025","journal-title":"Mycobiology"},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"Shafiei, M., Peyton, L., Hashemzadeh, M., and Foroumadi, A. (2020). History of the Development of Antifungal Azoles: A Review on Structures, SAR, and Mechanism of Action. Bioorg. Chem., 104.","DOI":"10.1016\/j.bioorg.2020.104240"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"3390","DOI":"10.1021\/acs.chemrev.0c00199","article-title":"Antifungal Drug Resistance: Molecular Mechanisms in Candida albicans and Beyond","volume":"121","author":"Lee","year":"2021","journal-title":"Chem. Rev."},{"key":"ref_74","doi-asserted-by":"crossref","unstructured":"Mallick, U., Sahu, B.K., Hegde, R., Jena, P., Turuk, J., Sahu, M.C., and Panda, S.K. (2025). Antifungal Resistance in Vaginal Candidiasis Among Reproductive-Age Women: A Review. Curr. Pharm. Biotechnol., 26, Epub ahead of print.","DOI":"10.2174\/0113892010368329250503175104"},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"Garcia-Effron, G. (2020). Rezafungin\u2014Mechanisms of Action, Susceptibility and Resistance: Similarities and Differences with the Other Echinocandins. J. Fungi, 6.","DOI":"10.3390\/jof6040262"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"1214.e1","DOI":"10.1016\/j.cmi.2018.05.012","article-title":"Accuracy of Sensititre YeastOne Echinocandins Epidemiological Cut-off Values for Identification of FKS Mutant Candida albicans and Candida glabrata: A Ten Year National Survey of the Fungal Infection Network of Switzerland (FUNGINOS)","volume":"24","author":"Kritikos","year":"2018","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_77","doi-asserted-by":"crossref","unstructured":"Costa-de-Oliveira, S., and Rodrigues, A.G. (2020). Candida albicans Antifungal Resistance and Tolerance in Bloodstream Infections: The Triad Yeast-Host-Antifungal. Microorganisms, 8.","DOI":"10.3390\/microorganisms8020154"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.ad.2021.07.006","article-title":"Tirbanibulina: Revisi\u00f3n de Su Mecanismo de Acci\u00f3n Novedoso y de C\u00f3mo Encaja En El Tratamiento de La Queratosis Act\u00ednica","volume":"113","author":"Gilaberte","year":"2022","journal-title":"Actas Dermosifiliogr."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1111\/apm.13389","article-title":"Antifungal Drug Resistance in Candida: A Special Emphasis on Amphotericin B","volume":"132","author":"Ahmady","year":"2024","journal-title":"APMIS"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1007\/s40265-016-0538-7","article-title":"Liposomal Amphotericin B (AmBisome\u00ae): A Review of the Pharmacokinetics, Pharmacodynamics, Clinical Experience and Future Directions","volume":"76","author":"Stone","year":"2016","journal-title":"Drugs"},{"key":"ref_81","doi-asserted-by":"crossref","unstructured":"Carolus, H., Pierson, S., Lagrou, K., and Van Dijck, P. (2020). Amphotericin B and Other Polyenes-Discovery, Clinical Use, Mode of Action and Drug Resistance. J. Fungi, 6.","DOI":"10.3390\/jof6040321"},{"key":"ref_82","doi-asserted-by":"crossref","unstructured":"Czajka, K.M., Venkataraman, K., Brabant-Kirwan, D., Santi, S.A., Verschoor, C., Appanna, V.D., Singh, R., Saunders, D.P., and Tharmalingam, S. (2023). Molecular Mechanisms Associated with Antifungal Resistance in Pathogenic Candida Species. Cells, 12.","DOI":"10.3390\/cells12222655"},{"key":"ref_83","doi-asserted-by":"crossref","unstructured":"Zarei Mahmoudabadi, A., Zarrin, M., and Kiasat, N. (2014). Biofilm Formation and Susceptibility to Amphotericin B and Fluconazole in Candida albicans. Jundishapur. J. Microbiol., 7.","DOI":"10.5812\/jjm.17105"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"1353","DOI":"10.1099\/jmm.0.001036","article-title":"Candida auris: A Comparison between Planktonic and Biofilm Susceptibility to Antifungal Drugs","volume":"68","author":"Romera","year":"2019","journal-title":"J. Med. Microbiol."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"3579","DOI":"10.1128\/AAC.03065-15","article-title":"Biofilm Production and Antibiofilm Activity of Echinocandins and Liposomal Amphotericin B in Echinocandin-Resistant Yeast Species","volume":"60","author":"Escribano","year":"2016","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1016\/j.ijantimicag.2016.07.022","article-title":"Miltefosine Inhibits Candida albicans and Non-albicans Candida spp. Biofilms and Impairs the Dispersion of Infectious Cells","volume":"48","author":"Vila","year":"2016","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"435","DOI":"10.2147\/IDR.S285690","article-title":"Evaluation of Anti-Biofilm Capability of Cordycepin Against Candida albicans","volume":"14","author":"Wang","year":"2021","journal-title":"Infect. Drug Resist."},{"key":"ref_88","doi-asserted-by":"crossref","unstructured":"Fernandes, L., Fortes, B.N., Lincopan, N., and Ishida, K. (2020). Caspofungin and Polymyxin B Reduce the Cell Viability and Total Biomass of Mixed Biofilms of Carbapenem-Resistant Pseudomonas aeruginosa and Candida spp. Front. Microbiol., 11.","DOI":"10.3389\/fmicb.2020.573263"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1080\/08927014.2018.1472244","article-title":"Susceptibility of Candida glabrata Biofilms to Echinocandins: Alterations in the Matrix Composition","volume":"34","author":"Rodrigues","year":"2018","journal-title":"Biofouling"},{"key":"ref_90","first-page":"2133","article-title":"Antibiofilm Activity of Antifungal Drugs, Including the Novel Drug Olorofim, against Lomentospora prolificans","volume":"75","author":"Kirchhoff","year":"2020","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/j.mycmed.2019.04.003","article-title":"Activity of Base Analogues (5-Fluorouracil, 5-Flucytosine) against Planktonic Cells and Mature Biofilm of Candida Yeast. Effect of Combination with Folinic Acid","volume":"29","author":"Nawrot","year":"2019","journal-title":"J. Mycol. Med."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1007\/s00294-013-0400-3","article-title":"Recent Insights into Candida albicans Biofilm Resistance Mechanisms","volume":"59","year":"2013","journal-title":"Curr. Genet."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1111\/jam.14949","article-title":"Biofilm of Candida albicans: Formation, Regulation and Resistance","volume":"131","author":"Pereira","year":"2021","journal-title":"J. Appl. Microbiol."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1038\/s44259-024-00046-3","article-title":"Mechanisms of Antimicrobial Resistance in Biofilms","volume":"2","author":"Liu","year":"2024","journal-title":"NPJ Antimicrob. Resist."},{"key":"ref_95","doi-asserted-by":"crossref","unstructured":"Kaur, J., and Nobile, C.J. (2023). Antifungal Drug-Resistance Mechanisms in Candida Biofilms. Curr. Opin. Microbiol., 71.","DOI":"10.1016\/j.mib.2022.102237"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"315","DOI":"10.4161\/trns.22281","article-title":"A Sticky Situation: Untangling the Transcriptional Network Controlling Biofilm Development in Candida albicans","volume":"3","author":"Fox","year":"2012","journal-title":"Transcription"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1038\/nrmicro.2017.107","article-title":"Development and Regulation of Single-and Multi-Species Candida albicans Biofilms","volume":"16","author":"Lohse","year":"2018","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_98","doi-asserted-by":"crossref","unstructured":"Kantroo, H.A., Mubarak, M.M., and Ahmad, Z. (2025). Exploring Therapeutic Strategies for Candidiasis: From Current Treatments to Future Perspectives. Bioorg. Chem., 164.","DOI":"10.1016\/j.bioorg.2025.108797"},{"key":"ref_99","doi-asserted-by":"crossref","unstructured":"Satora, M., Grunwald, A., Zaremba, B., Frankowska, K., \u017bak, K., Tarkowski, R., and Ku\u0142ak, K. (2023). Treatment of Vulvovaginal Candidiasis\u2014An Overview of Guidelines and the Latest Treatment Methods. J. Clin. Med., 12.","DOI":"10.3390\/jcm12165376"}],"container-title":["Journal of Fungi"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2309-608X\/11\/9\/620\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:32:34Z","timestamp":1760034754000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2309-608X\/11\/9\/620"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,25]]},"references-count":99,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["jof11090620"],"URL":"https:\/\/doi.org\/10.3390\/jof11090620","relation":{},"ISSN":["2309-608X"],"issn-type":[{"value":"2309-608X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,25]]}}}