Antifungal susceptibility testing of vulvovaginal species among women attending antenatal clinic in tertiary care hospitals of Peshawar.

BACKGROUND

Vulvovaginal candidiasis (VVC) is considered as a pervasive gynecological problem among women worldwide. Owing to this fact, in the current study, we aimed at assessing the prevalence rate of spp. causing VVC in symptomatic pregnant women and their antifungal susceptibility pattern.

METHODS

This study was carried out in the tertiary care hospitals of Peshawar during the period of July 1, 2016 to December 31, 2016. The study group included 450 pregnant women in the age group of 17-44 years with symptoms of excessive vaginal discharge, pain and pruritis. In all, 108 pregnant women were culture positive for . Antimicrobial susceptibility testing (AST) was conducted on specimens against various azoles and polyene F group of antifungals.

RESULTS

Out of 108 spp. isolated from vaginal swabs, there were 45 (41.7%) , 18 (16.7%) , 18 (16.7%) , 16 (14.8%) and 11 (10.2%) . According to age distribution, 27 years was the mean age. Pregnancy trimester distribution among patients was as follows: 21 (19.4%) patients were in their first trimester, 65 (60.2%) patients were in their second trimester and 22 (20.4%) patients were in the third trimester. Susceptibility of fluconazole was determined as follows: 33.3% of the isolates were sensitive, 4.6% were susceptible dose dependent (SDD) and 62% were resistant. Susceptibility of spp. with respect to nystatin in patients with VVC was as follows: 25% were sensitive, 16.7% were SDD and 58.3% were resistant. Susceptibility of clotrimazole was analyzed, and it was sensitive in 21.3% of patients, SDD in 19.4% of patients and resistant in 59.3% of patients. Voriconazole susceptibility was recorded to be sensitive in 85.2% of patients, SDD in 4.6% of patients and resistant in 10.2% of patients suffering from VVC. Susceptibility results for itraconazole in patients with VVC were as follows: 42.6% of patients were sensitive, 16.7% of patients were SDD, and 40.7% of patients were resistant.

CONCLUSION

In this study, frequency of VVC was noted to be high in the second trimester of pregnancy, with the highest frequency of isolated, followed by and . Antifungal susceptibility testing revealed that fluconazole was exceedingly resistant against species (62%), followed by clotrimazole (59.3%) and nystatin (58.3%). On the contrary, voriconazole had the highest antimicrobial activity against species (85.2%).