Prevalence and Antifungal Susceptibility of Candida albicans Causing Vaginal discharge Among Pregnant Women in Lebanon

Abstract

Background: Vaginal candidiasis is frequently prevalent in pregnant women and is associated with sepsis and adverse neonatal outcomes. This study determined the presence of Candida species in symptomatic pregnant women and evaluated the antifungal susceptibility profile of the isolated strains. It also aimed to explore whether Candida species predicts gestational complications and adverse neonatal outcomes. Methods: A total of 258 pregnant women at 35 to 37 week of gestation participated in this study. Vaginal swabs from these patients were collected at various obstetrics and gynecology clinics in Lebanon for a period of 12 months. Candida isolates were identified at species level and antifungal susceptibility of Candida albicans to fluconazole (FCZ), amphotericin B (AMB), itraconazole (ICZ) and voriconazole (VCZ) was determined by the agar-based E-test method. Results: Among 258 women tested, 100 (39%) were positive for Candida species. C. albicans, C. glabrata and C. krusei were isolated from 42%, 41% and 17% of the women, respectively. C. albicans had significant positive associations with gestational diabetes while C. kreusi or C. glabrata had significant positive associations with gestational complications and vaginal discharge. The antifungal susceptibility tests of C. albicans isolates revealed 97.5%, 90%, 87.5% and 97.5% susceptibility to AMB, FCZ, ICZ and VCZ, respectively. . Conclusion: The current study revealed high incidence of both C. albicans and non-C. albicans strains causing vulvovaginitis among pregnant women in Beirut, Lebanon. Whereas the susceptibility rates of C. albicans against AMB and VCZ were high, FCZ and ICZ proved comparatively less efficacious. The resistance profile of circulating C. albicans among pregnant women can predict the best outcome of appropriate prophylaxis or treatment of neonatal candidiasis. Vaginal candida colonization might lead to adverse neonatal outcome or gestational complications thus Candida screening as antennal follow up is advised.

Prevalence and Risk Factors of Vulvovaginal Candidosis during Pregnancy: A Review

“…A statistically significant association between diabetes and the rate of VVC during pregnancy had been found in a study by Masri et al [39] which follows the result found by Kanagal [40]. C. albicans was found to be significantly associated with gestational diabetes [33]. Nevertheless, several studies did not find any significant statistical relationship between diabetes and VVC during pregnancy [29,36,43].…”

“…Waikhom et al [27] found the highest cumulative prevalence of NAC spp., 74.1%, where C. glabrata alone accounted for 57.4% of prevalence among pregnant women in Ho municipality, Ghana. Ghaddar et al [33] and Sangaré et al [25] also found 58% and 59.61% prevalence of NAC spp., respectively. Another study by Ghaddar et al is where 56.6% (C. glabrata 44.5%) prevalence of NAC spp.…”

Evaluation of ERG-11 Gene Expression in Azole Resistant Candida Isolates From Various Clinical Specimens In ICUs

“…and 95% were susceptible to Voriconazole and 5% were resistant. Our findings agree with Ghaddar et al [28] who detected nearly similar results. Furthermore, Zeng et al reported a total of 18.6% of the candida isolates were resistant to fluconazole.…”

Association of vaginal dysbiosis and gestational diabetes mellitus with adverse perinatal outcomes

“…albicans in the GDM group. Similar to our study, Ghaddar et al 25 also found an increased prevalence of NCAC and an association of C . albicans with GDM.…”