molecular characterization and antifungal susceptibility of candida species isolated from vulvovaginitis in jahrom city, south of iran

Background: vulvovaginal candidiasis (vvc) is a significant health issue due to candida spp. although candida albicans is considered a major causative agent of vaginal candidiasis, non-albicans species have increased during previous decades. objectives: this research aimed at molecular identification and assessing antifungal susceptibility of vvc isolated candida spp. methods: a professional physician examined two hundred and ninety-five suspected females with vaginitis. the specimens were collected by sterile cotton swabs. swabs were inoculated on sabouraud dextrose agar plates and then incubated for 48 - 72 hours at 35°c. polymerase chain reaction-restriction fragment length polymorphism (pcr-rflp) was used to detect all candida species. broth microdilution, according to the m27-a3 and m27-s4 clsi documents, were employed for determining the antifungal susceptibility tests of caspofungin (cas), voriconazole (vrc), itraconazole (itc), fluconazole (flu), clotrimazole (clo), ketoconazole (kto), amphotericin b (amb), and nystatin (nys). results: a total of 295 females suspected of vulvovaginal candidiasis were examined. the culture results were positive in 50.5% (149 of 295) of specimens. according to molecular identification techniques, c. albicans 133/149 (89.2%), c. glabrata 8/149 (5.4%), and c. kefyr 2/149 (1.4%) were the main species. a mixed infection of c. albicans and c. glabrata 6/149 (4 %) was detected. the geometric mean values to all candida strains were in increasing order as the following: cas, 0.075 μg/ml; vrc, 0.091 μg/ml; itc, 0.15 μg/ml; amb, 0.22 μg/ml; clo, 0.23 μg/ml; kto, 0.28 μg/ml; nys, 0.88 μg/ml; flu, 1.48 μg/ml. further, the mic ranges of all candida isolates to the tested antifungal agents were in increasing order as follows: cas: 0.031 - 0.25 μg/ml, kto and itc: 0.031 - 2 μg/ml, vrc: 0.031 - 4 μg/ml, clo and amb: 0.031 - 8 μg/ml, nys: 0.06 - 4 μg/ml, and flu: 0.12 - 128 μg/ml. conclusions: we reported 1 (7.2 %) c. glabrata isolate resistance to flu and 2 (14.3%) c. glabrata isolates susceptible-dose-dependent (sdd) to cas. we also reported 6 (4.5%), 5 (3.8%), and 2 (1.5%) c. albicans resistance to itc, flu, and amb, respectively, but 100% c. albicans susceptible to cas and vrc.