Division of Infectious Diseases, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA.
Mycoses. 2023 Jul;66(7):563-565. doi: 10.1111/myc.13582. Epub 2023 Mar 13.
Recurrent vulvovaginal candidiasis (RVVC), despite its worldwide prevalence, has limited treatment options; and a long-term prophylactic regimen utilising fluconazole is the dominant choice.
An increase in fluconazole resistance is reported, and little information is available about the reversibility of resistance status following the withdrawal of fluconazole.
Repeated antifungal susceptibility tests (ASTs) for fluconazole at a median interval of 3 months between them were evaluated in women with refractory or recurrent VVC patients at the Vaginitis clinic from 2012 to 2021 (10 years) and performed at pH 7 and pH 4.5 using the broth microdilution tests based on the CLSI M27-A4 reference method.
Of 38 patients with long-term follow-up with repeat ASTs, 13 patients (13/38, 34.2%) tested at pH 7.0 remained susceptible to fluconazole with MIC ≤2 μg/mL. Nineteen patients (19/38, 50%) remained resistant to fluconazole with MIC ≥8 μg/mL, whereas four (4/38, 10.5%) changed from susceptible to resistant and two (2/38, 5.2%) changed from resistant to susceptible over time. At pH 4.5, among the 37 patients with repeated MIC values, nine (9/37, 24.3%) remained susceptible to fluconazole and 22 (22/37, 59.5%) remained resistant. Three isolates (3/37, 8.1%) changed from susceptible to resistant, while 3 (3/37, 8.1%) changed from resistant to susceptible over time.
Fluconazole susceptibility in Candida albicans vaginal isolates obtained longitudinally in women with RVVC remains stable with rare reversal of resistance despite azole avoidance.
复发性外阴阴道念珠菌病（RVVC）尽管在全球范围内普遍存在，但治疗选择有限；长期预防性氟康唑治疗方案是主要选择。
据报道，氟康唑耐药性有所增加，而关于氟康唑停药后耐药状态的逆转情况，相关信息有限。
对 2012 年至 2021 年（10 年）在阴道炎诊所就诊的难治性或复发性 VVC 患者进行了重复氟康唑抗真菌药敏试验（AST），中位间隔为 3 个月，并在 pH7 和 pH4.5 下进行，使用基于 CLSI M27-A4 参考方法的肉汤微量稀释试验。
在进行了长期重复 AST 检测的 38 例患者中，13 例（13/38，34.2%）在 pH7.0 下仍对氟康唑敏感，MIC≤2μg/mL。19 例（19/38，50%）对氟康唑仍耐药，MIC≥8μg/mL，而 4 例（4/38，10.5%）的耐药性从敏感转为耐药，2 例（2/38，5.2%）的耐药性从耐药转为敏感。在 pH4.5 下，在 37 例有重复 MIC 值的患者中，9 例（9/37，24.3%）仍对氟康唑敏感，22 例（22/37，59.5%）仍耐药。3 株（3/37，8.1%）的耐药性从敏感转为耐药，而 3 株（3/37，8.1%）的耐药性从耐药转为敏感。
在 RVVC 女性患者中纵向获得的白色念珠菌阴道分离株的氟康唑敏感性保持稳定，尽管避免使用唑类药物，但耐药性很少逆转。
