Fluconazole Resistance in Vulvovaginal Yeasts Increases

TOPLINE:

Fluconazole resistance in yeast isolates from women with recurrent vulvovaginal candidiasis in Leeds, England, increased from 3.5% to 9.6% over 3 years. Non-Candida albicans yeasts also rose from 6.0% to 12.6% during the same period.

METHODOLOGY:

• Researchers conducted a retrospective data search of vaginal cultures from adult women in Leeds, England, between April 2018 and March 2021.
• A total of 5461 vaginal samples from women with clinical information indicating complicated/recurrent vulvovaginal candidiasis were included.
• Samples were processed on the WASPLAB automated platform, and species identification and antifungal susceptibility testing were performed in the Mycology Reference Centre by Matrix-assisted laser desorption ionization–time-of-flight mass spectrometry.
• Susceptibility to fluconazole was determined using disc diffusion and the Sensititre YeastOne microbroth dilution assay.

TAKEAWAY:

• According to the authors, the prevalence of non-Candida albicans yeasts increased from 6.0% in 2018-2019 to 12.6% in 2020-2021 (P = .0003).
• Fluconazole-sensitive (dose-dependent) and Fluconazole-resistant isolates increased from 3.5% in 2018-2019 to 9.6% in 2020-2021 (P = .0001).
• Most fluconazole resistance was observed in Candida albicans, with other species such as Nakaseomyces glabrata and Pichia kudriavzevii also showing resistance.
• The authors state that the increase in fluconazole resistance and non-Candida albicans yeasts may be linked to a policy change encouraging empirical treatment of vulvovaginal candidiasis in primary care.

IN PRACTICE:

“This study shows that the rates of non-Candida albicans and fluconazole-resistant C. albicans have increased year on year in the 3 years studied. The exact reasons for this increase remain unclear, but it follows the introduction of restricted access to fungal cultures for the diagnosis of vulvovaginal candidiasis by those working in primary care. A clinical diagnosis, followed by empirical treatment, has been recommended instead. Consequently, we believe this policy of encouraging empirical vaginitis treatment based on nonspecific symptoms and signs needs revisiting,” the authors wrote.

SOURCE:

The study was led by Jennifer C. Ratner, Janet Wilson, Kevin Roberts, Catherine Armitage, and Richard Christopher Barton, Leeds Teaching Hospitals NHS Trust, Leeds, England. It was published online on August 9 in Sexually Transmitted Infections.

LIMITATIONS:

The study’s limitations included a potential bias introduced by the reduced number of samples received from specialist sexual health clinics during the COVID-19 pandemic. Additionally, the study could not distinguish between cases of recurrent vulvovaginal candidiasis with complete resolution of symptoms and those with persistent symptoms despite treatment.

DISCLOSURES:

Richard Christopher Barton disclosed receiving fees from Pfizer Ltd for contributing to webinar presentations in 2023. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.