Antifungal Resistance Pattern of Candida Species Isolated from High Vaginal Swabs of Women Attending a Hospital in Enugu State, Nigeria

Abstract

There is an increase in non-albicans Candida (NAC) vulvovaginal candidiasis which is attributed to overuse of antifungal therapy and this has led to antifungal resistance. This study was aimed at determining the antifungal resistance pattern of some clinical isolates of Candida species. Eighty-eight (88) isolates were used which included Candida tropicalis (34), Candida Parapsilosis (21), Candida albicans (20), Candida krusei (7) and Candida glabrata (6). The drugs used were Fluconazole (25µg), Ketoconazole (10µg), Voriconazole (1µg), Nystatin (100Units), Amphotericin B (20µg), Flucytosine (1µg), Clotrimazole (10µg) and Itraconazole (50µg). The susceptibility testing was carried out using the M44-A standard method for yeast disk diffusion testing. Results showed that the percentages of Candida species resistant to Fluconazole, Ketoconazole, Voriconazole, Amphotericin B, Flucytosine, Clotrimazole and Itraconazole and Nystatin were 52.3%, 61.9%, 35.2%, 19.3%, 86.4%, 34.1%, 45.5% and 44.3%, with inhibition zone diameters ≤14mm, ≤20mm, ≤13mm, <10mm, ≤11mm, ≤11mm, ≤13mm and no inhibition zone diameter respectively. Candida krusei was the most resistant species with 100% resistance to each of Fluconazole, Ketoconazole and Flucytosine. Candida tropicalis was the species with the highest susceptibility (79.4%) to Amphotericin B followed by Candida parapsilosis with inhibition zone diameters ≥15mm. While Candida glabrata showed 100% resistance to each of Flucytosine and Itraconazole, Candida albicans showed 100% resistance to Flucytosine only. Candida glabrata was the only Candida species with 0% resistance to Amphotericin B. The drug to which most of the Candida species were susceptible was Amphotericin B followed by Voriconazole while Flucytosine was the drug with the highest resistance followed by Ketoconazole and Fluconazole. The highest number of susceptible-dose dependent Candida isolates was observed with Ketoconazole (25%), followed by Clotrimazole and Itraconazole, each recording 23.9%. Based on the findings of the present study, Voriconazole is recommended for vaginal candidiasis especially in the study area and also especially for infections caused by Fluconazole-resistant Candida species. This suggests that routine sensitivity testing is pertinent to guiding the choice of antifungal therapy. Thus, indiscriminate use of antifungal drugs should be avoided to reduce the development and spread of resistance.

Recent trends in the Susceptibility pattern of Candida to Fluconazole and Amphotericin B at a tertiary care center in South India

“…10 In the current study, Candida species isolated were C. tropicalis 34 (68%) C. albicans 12(24%) and C. parapsilosis 4 (08%) from various specimens, this has the same pattern as the studies conducted elsewhere. 11,12 The resistance pattern for the Candida species shows that C. tropicalis isolates showed 12% resistance to fluconazole and 6% to amphotericin B. The study by Urvashi et al showed that there was 59% and 9.4% resistance for C. tropicalis against fluconazole and amphotericin B which is slightly higher than our study.…”

Vaginal Candidiasis Caused by Candida Non Albicans: Epidemiological and Mycological Aspects at the University Hospital Center of Brazzaville

“…On the other hand, the increase in their incidence could be attributable to the selection pressure exerted by the increasingly increasing use of azoles in the treatment of certains cancers and vaginal candidiasis. [28]. The increase in non-albicans Candida species should raise fears of an increasingly frequent occurrence of recurrent vaginal candidiasis.…”

In-vitro and In-vivo Anti-Candidal Effect of Cnidoscolus aconitifolius Leaves Extracts

“…Candida is an opportunistic normal flora of the human reproductive and gastrointestinal mucosa and may be isolated from the mouth, vagina, gut, and throat [1]. The transition from a harmless commensal to a disease causing pathogen depends on the immune system of the host and virulence factors of the Candida species [2].…”

“…More than 90% of immunocompromised persons, which are HIV patients, present with oral candidiasis [3]. Seventy-five percent of women experience a Candida infection at least once in their lifetime [1] and this could result in systemic infections that are fatal to pregnant women and critically unwell patients with a fatality rate of approximately 30% [4].…”

“…Pfaller et al [6] reported the statistics of the drug resistance towards Miconazole, Ketoconazole, Clotrimazole, and Fluconazole as shown by various Candida species as C. krusei (20%), C. albicans (89.3%), C. glabrata (14.2%), and C. glabrata (42.9%) respectively. Resistance to polyene has been discovered mostly in clinical isolates of non-albicans Candida such as Candida glabrata, Candida parapsilosis, Candida tropicalis, and Candida lusitaniae [1]. Thus, there is a need for alternative treatment, which is where medicinal plants come in.…”