Identification and Susceptibility Profile of Vaginal Candida Species to Antifungal Agents among Pregnant Women Attending the Antenatal Clinic of Thika District Hospital, Kenya

Abstract

Fungal infections have emerged as a worldwide health care problem in recent years, owing to the extensive use of broad-spectrum antibiotics. We screened 104 pregnant women with symptoms of vaginal candidiasis in the antenatal clinic of Thika District Hospital, Kenya in order to identify vaginal Candida species and determine their susceptibility profile to commonly used antifungal drugs for treatment of the infection. The drugs tested were fluconazole, ketoconazole, itraconazole, clotrimazole and topical nystatin. Vaginal swabs were collected and subjected to mycological and biochemical tests for Candida species identification. Susceptibility profile of the identified vaginal Candida species to the antifungal drugs was carried out using broth micro-dilution minimum inhibiting concentration method based on the approved National Committee for Clinical Laboratory Standards (NCCLS, 2002) guidelines. Candida albicans was susceptible to most of the azoles drugs while the other species had varying responses. Candida krusei and Candida glabrata species isolated were resistant to fluconazole and ketoconazole. Candida albicans isolates had a high susceptibility to itraconazole (88.33%). Five percent (5%) of the isolates were susceptible in dose dependent (S-DD) with Minimum Inhibitory Concentrations (MICs) of 0.25 - 0.5 μg/ml while 11.67% of C. albicans isolates were resistant (MICs ≥ 1 μg/ml). Itraconazole resistance was highest among C. glabrata isolates (50%) while 32.14% were S-DD (MICs 0.25 - 0.5 μg/ml). Only 17.85% of the C. glabrata isolates were susceptible (MICs of ≤ 0.125 μg/ml). All isolates of Candida isolates were susceptible to itraconazole and clotrimazole except C. krusei which was 100% resistant to clotrimazole. All Candida species isolates had low susceptibility to topical nystatin except Candida parapsilosis that was 100% susceptible. Data also showed an emerging resistance of Candida krusei to most of the drugs used except itraconazole. The results of this study support the continued use of these antifungal drugs for the treatment of vaginal candidiasis in the pregnant women except topical nystatin.