Antifungal Testing of Vaginal <i>Candida</i> Isolates in Pregnant Women: A Retrospective, Single-Center Study in Adana, Türkiye

Clinical and mycological data are essential for the optimal management of patients with <i>Candida</i> vaginitis (CV), particularly in cases of (i) azole-resistant <i>C</i>. <i>albicans</i> vaginitis, (ii) recurrent CV, and (iii) CV in pregnant women. The present...

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Main Authors: Mete Sucu, Nevzat Ünal, Ayşe Sultan Karakoyun, İrem Şahin, Oğuzhan Bingöl, Fatih Hüner, Fatma İşlek Uzay, İlker Ünal, Dilek Yeşim Metin, Macit Ilkit
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Language:English
Published: MDPI AG 2025-01-01
Series:Journal of Fungi
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Online Access:https://www.mdpi.com/2309-608X/11/2/92
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author Mete Sucu
Nevzat Ünal
Ayşe Sultan Karakoyun
İrem Şahin
Oğuzhan Bingöl
Fatih Hüner
Fatma İşlek Uzay
İlker Ünal
Dilek Yeşim Metin
Macit Ilkit
author_facet Mete Sucu
Nevzat Ünal
Ayşe Sultan Karakoyun
İrem Şahin
Oğuzhan Bingöl
Fatih Hüner
Fatma İşlek Uzay
İlker Ünal
Dilek Yeşim Metin
Macit Ilkit
author_sort Mete Sucu
collection DOAJ
description Clinical and mycological data are essential for the optimal management of patients with <i>Candida</i> vaginitis (CV), particularly in cases of (i) azole-resistant <i>C</i>. <i>albicans</i> vaginitis, (ii) recurrent CV, and (iii) CV in pregnant women. The present retrospective single-center study investigated the antifungal activity of six commonly used antifungals against randomly selected vaginal isolates recovered from 68 pregnant women in Adana, Türkiye, including <i>C</i>. <i>albicans</i>, petite <i>C</i>. <i>glabrata</i>, non-petite <i>C</i>. <i>glabrata</i>, and <i>C</i>. <i>krusei</i>, using the disk diffusion method at pH 4 and 7. Furthermore, the antifungal activities of fluconazole and itraconazole were also assessed using the broth microdilution method. For all isolates, the mean inhibition zone diameters were narrower for itraconazole and ketoconazole and larger for miconazole at pH 4 than pH 7 (<i>p</i> < 0.05). For nystatin, zone diameters were wider in <i>C</i>. <i>albicans</i> and petite <i>C</i>. <i>glabrata</i> at pH 4 (<i>p</i> < 0.001 and <i>p</i> < 0.001). Remarkably, clotrimazole was more active at pH 4 than at pH 7, except against non-petite <i>C</i>. <i>glabrata</i> isolates. Based on the broth microdilution results, the resistance rate was higher at pH 4 than at pH 7 in all isolates. <i>Candida glabrata</i> petite isolates exhibited MIC values 2 to 5 times higher than those of the non-petite isolates for both fluconazole and itraconazole. This study highlights the potent activity of topical antifungals (miconazole, nystatin, and clotrimazole) for the treatment of CV in pregnant women and highlights the need to identify petite and non-petite mutants of vaginal <i>C</i>. <i>glabrata</i> isolates to obtain more reliable data and for antifungal susceptibility testing prior to decision-making. The results of the two antifungal susceptibility methods were compared for <i>C. albicans</i> and <i>C. glabrata</i> isolates, and the reliability of the disk diffusion test was discussed.
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spelling doaj-art-a84de3f4ccab45178431fb42e8c53d6c2025-08-20T02:04:06ZengMDPI AGJournal of Fungi2309-608X2025-01-011129210.3390/jof11020092Antifungal Testing of Vaginal <i>Candida</i> Isolates in Pregnant Women: A Retrospective, Single-Center Study in Adana, TürkiyeMete Sucu0Nevzat Ünal1Ayşe Sultan Karakoyun2İrem Şahin3Oğuzhan Bingöl4Fatih Hüner5Fatma İşlek Uzay6İlker Ünal7Dilek Yeşim Metin8Macit Ilkit9Division of Perinatology, Department of Obstetrics and Gynecology, Faculty of Medicine, Çukurova University, Adana 01330, TürkiyeDivision of Mycology, Department of Microbiology, Faculty of Medicine, Çukurova University, Adana 01330, TürkiyeDivision of Mycology, Department of Microbiology, Faculty of Medicine, Çukurova University, Adana 01330, TürkiyeDivision of Mycology, Faculty of Medicine, University of Ege, Bornova, Izmir 35100, TürkiyeDivision of Mycology, Department of Microbiology, Faculty of Medicine, Çukurova University, Adana 01330, TürkiyeDivision of Mycology, Department of Microbiology, Faculty of Medicine, Çukurova University, Adana 01330, TürkiyeDivision of Perinatology, Department of Obstetrics and Gynecology, Faculty of Medicine, Çukurova University, Adana 01330, TürkiyeDepartment of Biostatistics, Faculty of Medicine, Çukurova University, Adana 01330, TürkiyeDivision of Mycology, Faculty of Medicine, University of Ege, Bornova, Izmir 35100, TürkiyeDivision of Mycology, Department of Microbiology, Faculty of Medicine, Çukurova University, Adana 01330, TürkiyeClinical and mycological data are essential for the optimal management of patients with <i>Candida</i> vaginitis (CV), particularly in cases of (i) azole-resistant <i>C</i>. <i>albicans</i> vaginitis, (ii) recurrent CV, and (iii) CV in pregnant women. The present retrospective single-center study investigated the antifungal activity of six commonly used antifungals against randomly selected vaginal isolates recovered from 68 pregnant women in Adana, Türkiye, including <i>C</i>. <i>albicans</i>, petite <i>C</i>. <i>glabrata</i>, non-petite <i>C</i>. <i>glabrata</i>, and <i>C</i>. <i>krusei</i>, using the disk diffusion method at pH 4 and 7. Furthermore, the antifungal activities of fluconazole and itraconazole were also assessed using the broth microdilution method. For all isolates, the mean inhibition zone diameters were narrower for itraconazole and ketoconazole and larger for miconazole at pH 4 than pH 7 (<i>p</i> < 0.05). For nystatin, zone diameters were wider in <i>C</i>. <i>albicans</i> and petite <i>C</i>. <i>glabrata</i> at pH 4 (<i>p</i> < 0.001 and <i>p</i> < 0.001). Remarkably, clotrimazole was more active at pH 4 than at pH 7, except against non-petite <i>C</i>. <i>glabrata</i> isolates. Based on the broth microdilution results, the resistance rate was higher at pH 4 than at pH 7 in all isolates. <i>Candida glabrata</i> petite isolates exhibited MIC values 2 to 5 times higher than those of the non-petite isolates for both fluconazole and itraconazole. This study highlights the potent activity of topical antifungals (miconazole, nystatin, and clotrimazole) for the treatment of CV in pregnant women and highlights the need to identify petite and non-petite mutants of vaginal <i>C</i>. <i>glabrata</i> isolates to obtain more reliable data and for antifungal susceptibility testing prior to decision-making. The results of the two antifungal susceptibility methods were compared for <i>C. albicans</i> and <i>C. glabrata</i> isolates, and the reliability of the disk diffusion test was discussed.https://www.mdpi.com/2309-608X/11/2/92antifungal susceptibility tests<i>Candida albicans</i><i>Candida glabrata</i>fluconazolepetitevaginitis
spellingShingle Mete Sucu
Nevzat Ünal
Ayşe Sultan Karakoyun
İrem Şahin
Oğuzhan Bingöl
Fatih Hüner
Fatma İşlek Uzay
İlker Ünal
Dilek Yeşim Metin
Macit Ilkit
Antifungal Testing of Vaginal <i>Candida</i> Isolates in Pregnant Women: A Retrospective, Single-Center Study in Adana, Türkiye
Journal of Fungi
antifungal susceptibility tests
<i>Candida albicans</i>
<i>Candida glabrata</i>
fluconazole
petite
vaginitis
title Antifungal Testing of Vaginal <i>Candida</i> Isolates in Pregnant Women: A Retrospective, Single-Center Study in Adana, Türkiye
title_full Antifungal Testing of Vaginal <i>Candida</i> Isolates in Pregnant Women: A Retrospective, Single-Center Study in Adana, Türkiye
title_fullStr Antifungal Testing of Vaginal <i>Candida</i> Isolates in Pregnant Women: A Retrospective, Single-Center Study in Adana, Türkiye
title_full_unstemmed Antifungal Testing of Vaginal <i>Candida</i> Isolates in Pregnant Women: A Retrospective, Single-Center Study in Adana, Türkiye
title_short Antifungal Testing of Vaginal <i>Candida</i> Isolates in Pregnant Women: A Retrospective, Single-Center Study in Adana, Türkiye
title_sort antifungal testing of vaginal i candida i isolates in pregnant women a retrospective single center study in adana turkiye
topic antifungal susceptibility tests
<i>Candida albicans</i>
<i>Candida glabrata</i>
fluconazole
petite
vaginitis
url https://www.mdpi.com/2309-608X/11/2/92
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