Clinical resistance of recurrent Candida albicans vulvovaginitis to fluconazole in the presence and absence of in vitro resistance.

OBJECTIVE

To determine if failure of recurrent Candida albicans vulvovaginitis to respond clinically to fluconazole is related to in vitro mycologic resistance.

STUDY DESIGN

We compared clinical response to fluconazole with culture and sensitivity data in all cases of recurrent C albicans vulvovaginitis referred to our clinic over an 18-month period.

RESULTS

Of 52 patients referred to us with recurring vulvovaginitis, 10 were C albicans culture positive. All 10 had previously responded to fluconazole but subsequently failed fluconazole therapy. All were euglycemic and HIV negative. In 3 of the 10 isolates, the mean inhibitory concentration for fluconazole was > 64 micrograms/mL. The history of response to fluconazole in the 7 patients with susceptible isolates was indistinguishable from that of the 3 with resistant isolates. Five of the 10 patients were given multiagent antifungal therapy. Of 4 patients available for long-term follow-up in this group, all had negative fungal cultures. In contrast, 4 evaluable patients who received maintenance azole therapy were C albicans culture positive at long-term follow-up.

CONCLUSION

Recurrent C albicans vulvovaginitis can display clinical resistance to fluconazole that correlates with in vitro resistance in only some cases. We postulate that aberrant host response may play a role in the failure to control fungal colonization with a single fungistatic agent.