Identification and pattern of antifungal susceptibility of Candida species isolated from cases of vaginitis in a tertiary care hospital in India
,
Abstract
Background and Objectives: Vulvovaginal candidiasis (VVC) is one of the most frequent reasons for gynecological consultations. Candida albicans is responsible in the majority of cases. Lately, VVC caused by non-albicans Candida spp. (NAC), which are resistant to routinely used antifungals, is on the rise. This study was designed to determine the prevalence of Candida in patients suffering from vaginitis and to assess the predisposing factors along with identification of Candida species and evaluation of their susceptibility profile.
Materials and Methods: High vaginal swabs were collected from 225 women. Sample processing consisted of Gram stain and culture onto Sabouraud’s dextrose agar and HiChrom Candida Differential agar. Isolates were identified and speciated using VITEK2 Compact System. Susceptibility testing was done using VITEK2 AST-Y S08 cards and disc diffusion.
Results: Candida spp. were isolated from 94 (41.8%) of the cases. C. albicans was the predominant species (71.6%) followed by other NAC spp. (28.4%). Pregnancy and diabetes were the most frequently implicated risk factors (67.1% and 44.4%). High resistance was observed in NAC spp. as opposed to C. albicans to all antifungal agents tested.
Conclusion: Empirical therapy with routinely used antifungals can be initiated for C. albicans. In the case of NAC spp., identification should be followed by susceptibility testing.
2. Del-Cura González I, García-de-Blas González F, Cuesta TS, Martín Fernández J, Del-Alamo Rodríguez JM, Escriva Ferrairo RA, et al. Patient preferences and treatment safety for uncomplicated vulvovaginal candidiasis in primary health care. BMC Public Health 2011; 11: 63.
3. Wang FJ, Zhang D, Liu ZH, Wu WX, Bai HH, Dong HY. Species distribution and in vitro antifungal susceptibility of vulvovaginal Candida isolates in China. Chin Med J (Engl) 2016; 129: 1161-1165.
4. Fidel PL Jr. History and new insights into host defense against vaginal candidiasis. Trends Microbiol 2004; 12: 220-227.
5. Gross NT, Arias ML, Moraga M, Baddasarow Y, Jarstrand C. Species distribution and susceptibility to azoles of vaginal yeasts isolated prostitutes. Infect Dis Obstet Gynecol 2007; 2007: 82412.
6. Kalaiarasan K, Singh R, Chaturvedula L. Fungal profile of vulvovaginal Candidiasis in a tertiary care hospital. J Clin Diagn Res 2017; 11: DC06-DC09.
7. Ligozzi M, Bernini C, Bonora MG, De Fatima M, Zuliani J, Fontana R. Evaluation of the VITEK 2 system for identification and antimicrobial susceptibility testing of medically relevant gram-positive cocci. J Clin Microbiol 2002; 40: 1681-1686.
8. M44-A2 Method for Antifungal Disk Diffusion Susceptibility Testing of Yeasts; Approved Guideline—Second Edition (2009). www.clsi.org
9. Aniebue UU, Nwankwo TO, Nwafor MI. Vulvovaginal candidiasis in reproductive age women in Enugu Nigeria, clinical versus laboratory-assisted diagnosis. Niger J Clin Pract 2018; 21: 1017-1022.
10. Disha T, Haque F. Prevalence and risk factors of vulvovaginal Candidosis during pregnancy: A review. Infect Dis Obstet Gynecol 2022; 2022: 6195712.
11. Liu J, Zeng M, Yang L, Mao Y, He Y, Li M, et al. Prevalence of reproductive tract infections among women preparing to conceive in Chongqing, China: trends and risk factors. Reprod Health 2022; 19: 197.
12. Ahmad A, Khan AU. Prevalence of Candida species and potential risk factors for vulvovaginal candidiasis in Aligarh, India. Eur J Obstet Gynecol Reprod Biol 2009; 144: 68-71.
13. Ragunathan L, Poongothai GK, Sinazer AR, Kannaiyan K, Gurumurthy H, Jaget N, et al. Phenotypic characterization and antifungal susceptibility pattern to fluconazole in Candida species isolated from vulvovaginal Candidiasis in a tertiary care hospital. J Clin Diagn Res 2014; 8: DC01-4.
14. Disha T, Haque F. Prevalence and risk factors of vulvovaginal Candidosis during pregnancy: A Review. Infect Dis Obstet Gynecol 2022; 2022: 6195712.
15. Mulinganya G, De Vulder A, Bisimwa G, Boelens J, Claeys G, De Keyser K, et al. Prevalence, risk factors and adverse pregnancy outcomes of second trimester bacterial vaginosis among pregnant women in Bukavu, Democratic Republic of the Congo. PLoS One 2021; 16(10): e0257939.
16. Wang W, Hao J, An R. Abnormal vaginal flora correlates with pregnancy outcomes: A retrospective study from 737 pregnant women. Eur J Obstet Gynecol Reprod Biol 2022; 272: 64-68.
17. Gunther LSA, Martins HPR, Gimenes F, de Abreu ALP, Consolaro MEL, Svidzinski TIE. Prevalence of Candida albicans and non-albicans isolates from vaginal secretions: comparative evaluation of colonization, vaginal candidiasis and recurrent vaginal candidiasis in diabetic and non-diabetic women. Sao Paulo Med J 2014; 132: 116-120.
18. Masri SN, Noor SM, Nor LA, Osman M, Rahman MM. Candida isolates from pregnant women and their antifungal susceptibility in a Malaysian tertiary-care hospital. Pak J Med Sci 2015; 31: 658-661.
19. Aguin TJ, Sobel JD. Vulvovaginal candidiasis in pregnancy. Curr Infect Dis Rep 2015; 17: 462.
20. Marot-Leblond A, Nail-Billaud S, Pilon F, Beucher B, Poulain D, Robert R. Efficient diagnosis of vulvovaginal Candidiasis by use of a new rapid immunochromatography test. J Clin Microbiol 2009; 47: 3821-3825.
21. Mutua F, Revathi G, Machoki JM. Species distribution and antifungal sensitivity patterns of vaginal yeasts. East Afr Med J 2010; 87: 156-162.
22. Nyirjesy P. Vulvovaginal candidiasis and bacterial vaginosis. Infect Dis Clin North Am 2008; 22: 637-652.
| Files | ||
| Issue | Vol 15 No 2 (2023) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijm.v15i2.12484 | |
| Keywords | ||
| Candidiasis; Vaginitis; Resistance; Antifungals; Reproductive health | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
