Speciation and antifungal susceptibility pattern of Candida isolates from vulvovaginitis patients attending a tertiary care hospital in South India

Background: Vulvovaginal candidiasis is a global issue of concern due to its association with economic costs, sexually transmitted infections, and ascending genital tract infection leading to several complications in both pregnant as well as non-pregnant women. It is second to bacterial vaginosis affecting approximately 50–72% of women of reproductive age group. Resistance to antifungal agents has increased during the last decade. Thus, identification of Candida up to species level and its antifungal susceptibility testing is essential in the management of Candidal infections. Aim: To determine the prevalence of various Candida species among vaginal candidiasis and to determine the antifungal susceptibility pattern of the isolates. Materials and methods: A total of 56 Candida species were isolated from 200 clinical diagnosed cases of vaginitis over 6 months period. Growth on Sabouraud dextrose agar were evaluated according to standard protocol and further processed for Candida speciation on CHROM agar. Antifungal susceptibility testing was performed using the Etest method as recommended by Clinical and Laboratory Standards Institute (CLSI) M27-A3 document. Results: Out of 200 vaginitis patients, 56 were positive for Candida species. All the isolates were speciated comprising four species – C. albicans 24 (42.8%), C. krusei 20 (35.7%), C. tropicalis 7 (12.5%), and C. glabrata 5 (8.9%). Antifungal susceptibility testing result of all Candida isolates were 100% susceptible to amphotericin B, nystatin and voiconazole. C. krusei and C.glabrata isolates were showed 100% resistance to fluconazole and ketoconazole respectively. Conclusion: In the present study, C. albicans was most common species followed by C. krusei. Presumptive identification followed by confirmation of Candida species helps to initiate early appropriate antifungal treatment. The relatively higher resistance shown by Non-abicans Candida species to commonly prescribed antifungals (fluconazole and ketoconazole) emphasizes the need for routine antifungal susceptibility testing of all Candida isolates.