Identification and antifungal susceptibility of yeast species isolated from cases of vaginitis in a tertiary care hospital in Kashmir, India

Abstract

BACKGROUND: Vulvovaginal candidiasis (VVC) is one of the most frequent reasons for gynaecological consultations. C. albicans is responsible for most cases. Lately, VVC caused by non-albicans Candida spp. (NAC) which are more resistant to routinely used antifungals is on the rise. Hence, identification of Candida to species level and determination of susceptibility to antifungals is necessary for providing effective therapy.
OBJECTIVES: To study the prevalence of yeast species in cases of vaginitis, the associated risk factors and their antifungal susceptibility. Also, to compare conventional methods with automated methods so as to devise a cost-effective method of testing in our setting.
STUDY DESIGN: Comparative cross-sectional study to compare different methods of identification and antifungal susceptibilities.
PARTICIPANTS: Total of 225 patients were included along with 100 controls.
METHODS: Patient details were recorded and vaginal swabs collected. Candida species were identified by HiCrome/Cornmeal Agar and VITEK2 Compact System. Isolates were also sent for MALDI-TOF identification. Antifungal sensitivity was done by disc diffusion and VITEK.
RESULTS: On culture, 41% of the cases were positive for Candida. Most common species was C. albicans (71%), NAC spp. accounted for remaining 29%. Association of VVC with discharge, marriage, pregnancy and diabetes was significant. Both the methods showed good sensitivity for C. albicans (85-96%) as opposed to NAC spp. (52-65%). Higher rates of resistance were observed amongst NAC spp. Cost of culture sensitivity by conventional method was 50.87 INR (USD=0.71) and VITEK2 was 596.39 INR (USD=8.4).

CONCLUSIONS: In our setting, empirical therapy with routinely used antifungals can be initiated for C. albicans without the need for drug susceptibility testing. In case of NAC spp., identification should be followed by susceptibility testing.

IMPLICATIONS: Although the cost of automation is ten times more than conventional methods, as of now both methods need to be combined as they are complementary to each other.