Burden of Drug-resistant Candidiasis in women of Reproductive age with Vulvovaginal Candidiasis

Vulvovaginal candidiasis (VVC)- a multifactorial infectious disease caused by Candida albicans and Non-albicans Candida species. Over the years, a rising pattern in drug resistant candidiasis cases is being observed. This article discusses the resistance pattern observed in patients with vulvovaginal candidiasis.

To determine species distribution and antifungal susceptibility patterns of Candida species.

Isolation of Candida spp. from cases of vulvovaginitis.

Identification of Candida spp.

Determination of antifungal susceptibility of the identified species.

This study was conducted in Department of microbiology, Kalpana Chawla government medical college over a period of one year, 2022-2023. A total of 197 patients were included in the study. Two high vaginal swabs each, were collected from symptomatic patients of VVC. The samples were processed by standard microbiological techniques and subjected to antifungal susceptibility (AFS) by both Kirby Bauer Disc Diffusion (DD) method and by using Octofungi 1 HiMIC^TM plate kit. The data was analysed statistically and comparison of the resistance pattern by both the methods was done and depicted in the form of graphs.

Of 197 samples, 52 were positive for VVC. The species isolated were C. albicans (26), C. parapsilosis (10), C. tropicalis (9), C. krusei (5) and C. glabrata (2). For fluconazole, C. albicans, C. tropicalis showed no resistance by DD method and MIC testing. However, (1/2) of C. glabrata showed resistance by disc diffusion whereas both (2/2) were resistant by MIC. Regarding voriconazole, 3.8% resistance was observed for C. albicans, 50% for C. glabrata, 10% for C. parapsilosis and 11.1% for C. tropicalis by MIC testing. Similarly, for caspofungin, all species were susceptible by DD. Whereas, C. krusei, and C. tropicalis showed no resistance by MIC but C. albicans (3.8%), 50% C. glabrata and 10% C. parapsilosis showed resistance by MIC testing.

Testing by MIC method is a better method for antifungal susceptibility testing, as described by CLSI. Since resistance in Candida isolates is on a rise, so it is important to incorporate routine AFS testing which would improve patient outcomes and ultimately reduce morbidity and mortality.