Fluconazole resistance in candida isolates from vaginal discharge in women attending an Apex Regional Sexually Transmitted Infections Center

Abstract

Background: Globally, vulvovaginal candidiasis (VVC) is a common infection in women. Candida albicans is the most common agent. There is an increasing prevalence of non-albicans Candida (NAC) species, mostly in vulnerable populations, responding poorly to fluconazole, the drug of choice for VVC. It leads to treatment failure, especially in clinical isolates with intrinsic fluconazole resistance; hence, appropriate identification and antifungal susceptibility testing (AFST) are of paramount importance to ensure better clinical outcomes. Aims and Objective: The aim of this study was to identify different Candida species isolated from women with VVC and to evaluate their antifungal drug susceptibility pattern. A retrospective observational study including a total of 286 isolates of Candida spp. isolated from 729 women with vaginal discharge attending the Outpatient Department of an Apex Regional Sexually Transmitted Infections Center in North India over 1 year (June 2022–May 2023) was performed. Identification and AFST were performed as per standard microbiological procedures. Statistical analysis was carried out using the SPSS version 22.0 (SPSS Inc., Chicago, IL, USA). Data were presented as percentages and proportions. Results: Candida isolates were detected in 39.23% of women. The median age was 26–35 years. C. albicans was the most common isolate (60.8%), followed by Candida glabrata (31.8%), Candida tropicalis (4.19%), Candida parapsilosis (2.09%), Candida krusei (0.699%), and Candida kefyr (0.34%). Fluconazole resistance was seen in 29% of the isolates and susceptible dose-dependent in 32.15%. Conclusion: Increasing isolation of NAC species (39.2%) causing VVC and responding poorly to fluconazole (29% resistant strains) is a major concern. Timely and appropriate AFST will help improve the clinical outcome and quality of life.