Species distribution and antifungal sensitivity, patterns of vaginal yeasts at the Aga khan University Hospital

Abstract

Species-level identification of yeasts and antifungal susceptihility testing is not a common practice in Kenya. Thus there is limited information on the distribution of yeast species causing vaginal infections and their susceptibility patterns to antifungal agents. To identify yeast isolates in vaginal specimens to species level and determine their antifungal susceptibility patterns to llucytosine (SFC), amphotericin B (AMB), fluconazole (FCA) and itraconazole (lTR). Cross-sectional in vitro study Aga Khan University Hospital (AKUH), Nairobi One hundred and one yeasts isolated from women with vaginal discharge were identified to species level using the API Candida system. The isolates were then subjected to broth microdilution susceptibility testing and data was analyzed usingSl'S'S for Windows version 12.0. Calbicans was the prominent species (69.3%) followed by Cglahrufa (12.9%), Cfamata (S.O%), Ckrusei (3.0%), Ciparapsilosis (1.0%), unidentified Candida species (3.0%), Trichosporon species (3.0%) and Scerevisiae (3.0%). The percentages of Culbicans susceptible to flucytosine (SFC), amphotericin B (AMB), fluconazole (FCA) and itraconazole (ITR) were 94.3, 92.9, 100 and 90 respectively; that of non-albicans isolates were 93.S, 80.6, 77.4 and 29 respectively. There was no significant difference (p>O.OS) between the susceptibility of ('olhicans and non-albicans isolates to SFC and AMB, however there was a significant difference (p<O.OS) to FCA and ITR. Cialbicans is still the predominant species causing vulvovaginal candidiasis and demonstrates good susceptibility to all antifungal agents tested. Non-albicans yeasts are a significant cause of vulvovaginal candidiasis and demonstrated reduced susceptibility to all drugs, especially the azoles which are commonly used lor treatment of vaginal candidiasis. The isolation of non-albicans yeasts may have clinical implication given their reduced susceptibility to antifungals.