A Challenge for Clinical Laboratories: Detection of Antifungal Resistance in<i>Candida</i>Species Causing Vulvovaginal Candidiasis

Abstract

Vulvovaginal candidiasis (VVC) is an infection affecting millions of women worldwide every year, principally affecting the vulva and vagina, and is caused by yeasts that normally inhabit the vaginal mucosa. 1 Vulvovaginal candidiasis is considered an important public health problem worldwide, 2 and its incidence has increased in recent years. It is presently the first cause of vulvovaginitis in Europe and is the second greatest cause in the United States and Brazil, where it is exceeded only by bacterial vaginosis. Approximately 75% of adult women have at least 1 episode of VVC in their lifetimes, and of these, 40% to 50% will undergo new outbreaks of which 5% to 8% will reach the recurrent status (RVVC), with 4 or more episodes in a single year. glabrata, C. tropicalis, C. krusei, C. parapsilosis, C. lusitaniae), are also isolated, C. glabrata is the second most common yeast, and its treatment is considered a serious clinical challenge. he available therapeutic arsenal for treatment of VVC offers few options 10 and includes the imidazole and triazole agents, in topical and oral form. Among them are fluconazole (FLU), miconazole (MICO), itraconazole (ITR), and ketoconazole (KETO), and polyenes such as nystatin (NYS) and some vaginal formulations containing amphotericin B. Nystatin in the form of a cream or vaginal suppository has been used for nearly 3 decades, with a mean mycological cure rate of 75% to 80%. These data indicate the need for an in vitro antifungal susceptibility test (AST) that can be used routinely in clinical laboratories, which would aid in the management of patients with VVC and RVVC. resently the broth macro-and microdilution methods are considered to be the reference AST tests for yeasts. However, clinical laboratories consider these methods to be too