Increasing rate of non-Candida albicansyeasts and fluconazole resistance in yeast isolates from women with recurrent vulvovaginal candidiasis in Leeds, United Kingdom

Jennifer C Ratner; Janet Wilson; Kevin Roberts; Catherine Armitage; Richard Christopher Barton

doi:10.1136/sextrans-2024-056186

journal article Oct 08, 2024

Increasing rate of non-Candida albicansyeasts and fluconazole resistance in yeast isolates from women with recurrent vulvovaginal candidiasis in Leeds, United Kingdom

Jennifer C Ratner Janet Wilson

Kevin Roberts Catherine Armitage Richard Christopher Barton

Sexually Transmitted Infections Vol. 101 No. 1 pp. 21-26 · BMJ

View at Publisher Save 10.1136/sextrans-2024-056186

Abstract

ObjectivesAzoles have been the mainstay of recurrent vulvovaginal candidiasis (RVVC) for many years. Because of a recent anecdotal increase in non-Candida albicansyeasts (NCAY) and azole-resistantC. albicanscases, their prevalence was calculated from cultures for yeasts in women with complicated/RVVC over 3 years.MethodsRetrospective data search of vaginal cultures from adult women in Leeds, UK between April 2018 and March 2021 was conducted. Samples with clinical details of complicated/RVVC had full yeast identification and antifungal susceptibility performed. Differences in prevalence between 12-month periods were determined using χ2tests.ResultsOver the 3 years, cultures were performed on 5461 vaginal samples from women with clinical information indicating they had complicated/RVVC, RVVC, with 1828 (33.5%) growing yeasts.Over 85% of yeasts each year wereC. albicans, however the proportion declined yearly with an increase in NCAY species.Nakaseomyces glabratawas the most frequent NCAY species isolated, increasing from 2.8% in 2018–19 to 6.8% in 2020–21. Total NCAY species increased from 6.0% in 2018–19 to 12.6% in 2020–21. Fluconazole-sensitive dose-dependant (SDD) and resistant isolates increased from 3.5% in 2018–19 to 7.7% in 2019–20 and 9.6% in 2020–21. Most resistance was inC. albicansand the majority of cases were seen in primary care. Most fluconazole non-sensitive isolates were either SDD or resistant to itraconazole (77% and 23%, respectively) and were intermediate or resistant to voriconazole (36.4% and 60%, respectively).ConclusionThere was a significant increase in the prevalence of NCAY and fluconazole-resistantC. albicansin complicated/RVVC cultures over these 3 years. Successful treatment of such cases can be very challenging. The exact reasons for this increase remain unclear but it follows a policy change that encouraged a clinical diagnosis and empirical treatment of vulvovaginal candidiasis, rather than fungal culture, in primary care.

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Metrics

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References

Details

Published: Oct 08, 2024
Vol/Issue: 101(1)
Pages: 21-26

Authors

Department of Microbiology, College of Medicine, University of Iowa, Iowa City, Iowa 52240

Richard Christopher Barton

Cite This Article

Jennifer C Ratner, Janet Wilson, Kevin Roberts, et al. (2024). Increasing rate of non-Candida albicansyeasts and fluconazole resistance in yeast isolates from women with recurrent vulvovaginal candidiasis in Leeds, United Kingdom. Sexually Transmitted Infections, 101(1), 21-26. https://doi.org/10.1136/sextrans-2024-056186

Increasing rate of non-Candida albicansyeasts and fluconazole resistance in yeast isolates from women with recurrent vulvovaginal candidiasis in Leeds, United Kingdom

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