Background: Vulvovaginal candidiasis is a common mucosal infection among immunocompetent, healthy women, and is caused by opportunistic yeasts that belong to genus Candida. In this study, we isolated and identified the Candida species in the vagina of patients who admitted in Gynecology Department of Mahdieh Hospital in Tehran, Iran to evaluate the in vitro activities of fluconazole, miconazole, itraconazole and flucytosine against 191 clinical Candida isolates by the NCCLS microdilution method.
Methods: 191 Candida were isolated from vaginal secretions and identified with conventional mycological methods in the diagnosis of Candida species. The identity of all strains was confirmed genotypically by multiplex PCR. In vitro susceptibility testing of vaginal Candida isolates was performed by the NCCLS broth microdilution method. The results were read at 48 h.
Results: Most C. albicans isolates (>90%) were sensitive in vitro to the antifungal agents tested. Most C. glabrata isolates showed sensitivity to miconazole and then flucytosine while they were more resistant to Itraconazole and fluconazole. Many isolates of C. tropicalis were susceptible to miconazole and then fluconazole. They showed a little resistance to all antifungals tested and flucytosine-resistance was the most frequent in the C. tropicalis isolates. High susceptibility to miconazole was observed in isolates of C. krusei and their susceptibility to the rest of the antifungals tested was dose-dependent. fluconazole -resistance was the most frequent in the C. krusei isolates.
Conclusion: Most isolates tested were susceptible to miconazole. A trend toward increased resistance among C. glabrata and C. krusei strains to antifungals tested was noted. Our findings suggest that, miconazole should be the agent of choice for the treatment of resistant vaginal candidiasis.