Antifungal susceptibilities of Candida species causing vulvovaginitis and epidemiology of recurrent cases

Sandra S Richter; Rudolph P Galask; Shawn A Messer; Richard J Hollis; Daniel J Diekema; Michael A Pfaller

doi:10.1128/JCM.43.5.2155-2162.2005

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Antifungal susceptibilities of Candida species causing vulvovaginitis and epidemiology of recurrent cases

Journal article

Open access

Peer reviewed

Antifungal susceptibilities of Candida species causing vulvovaginitis and epidemiology of recurrent cases

Sandra S Richter, Rudolph P Galask, Shawn A Messer, Richard J Hollis, Daniel J Diekema and Michael A Pfaller

Journal of clinical microbiology, Vol.43(5), pp.2155-2162

05/2005

DOI: 10.1128/JCM.43.5.2155-2162.2005

PMCID: PMC1153777

PMID: 15872235

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Abstract

There are limited data regarding the antifungal susceptibility of yeast causing vulvovaginal candidiasis, since cultures are rarely performed. Susceptibility testing was performed on vaginal yeast isolates collected from January 1998 to March 2001 from 429 patients with suspected vulvovaginal candidiasis. The charts of 84 patients with multiple positive cultures were reviewed. The 593 yeast isolates were Candida albicans (n = 420), Candida glabrata (n = 112), Candida parapsilosis (n = 30), Candida krusei (n = 12), Saccharomyces cerevisiae ( n = 9), Candida tropicalis (n = 8), Candida lusitaniae (n = 1), and Trichosporon sp. (n = 1). Multiple species suggesting mixed infection were isolated from 27 cultures. Resistance to fluconazole and flucytosine was observed infrequently (3.7% and 3.0%); 16.2% of isolates were resistant to itraconazole (MIC > or = 1 microg/ml). The four imidazoles (econazole, clotrimazole, miconazole, and ketoconazole) were active: 94.3 to 98.5% were susceptible at < or =1 microg/ml. Among different species, elevated fluconazole MICs (> or = 16 microg/ml) were only observed in C. glabrata (15.2% resistant [R], 51.8% susceptible-dose dependent [S-DD]), C. parapsilosis (3.3% S-DD), S. cerevisiae (11.1% S-DD), and C. krusei (50% S-DD, 41.7% R, considered intrinsically fluconazole resistant). Resistance to itraconazole was observed among C. glabrata (74.1%), C. krusei (58.3%), S. cerevisiae (55.6%), and C. parapsilosis (3.4%). Among 84 patients with recurrent episodes, non-albicans species were more common (42% versus 20%). A > or = 4-fold rise in fluconazole MIC was observed in only one patient with C. parapsilosis. These results support the use of azoles for empirical therapy of uncomplicated candidal vulvovaginitis. Recurrent episodes are more often caused by non-albicans species, for which azole agents are less likely to be effective.

Antifungal Agents - pharmacology

Recurrence

Candidiasis, Vulvovaginal - epidemiology

Humans

Candidiasis, Vulvovaginal - drug therapy

Candida - isolation & purification

Candidiasis, Vulvovaginal - diagnosis

Candida - classification

Female

Iowa - epidemiology

Vagina - microbiology

Candida - drug effects

Microbial Sensitivity Tests - methods

Details

Title: Subtitle: Antifungal susceptibilities of Candida species causing vulvovaginitis and epidemiology of recurrent cases
Creators: Sandra S Richter - Department of Pathology, University of Iowa Roy J. and Lucille A. Carver College of Medicine, 200 Hawkins Drive, C606 GH, Iowa City, IA 52242-1009, USA. sandra-richter@uiowa.edu
Rudolph P Galask
Shawn A Messer
Richard J Hollis
Daniel J Diekema
Michael A Pfaller
Resource Type: Journal article
Publication Details: Journal of clinical microbiology, Vol.43(5), pp.2155-2162
DOI: 10.1128/JCM.43.5.2155-2162.2005
PMID: 15872235
PMCID: PMC1153777
NLM abbreviation: J Clin Microbiol
ISSN: 0095-1137
eISSN: 1098-660X
Publisher: United States
Language: English
Date published: 05/2005
Academic Unit: Dermatology; Infectious Diseases; Epidemiology; Pathology; Internal Medicine
Record Identifier: 9983986367102771

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