Characterization of Candida species isolated from vulvovaginal candidiasis by MALDI-TOF with in vitro antifungal susceptibility profiles

Document Type : Original Articles


1 Infectious and Tropical Diseases Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran

2 Department of Obstetrics and Gynecology, School of Medicine, Fasa University of Medical Sciences, Fasa, Iran

3 Department of Medical Mycology and Parasitology, School of Medicine, Fasa University of Medical Sciences, Fasa, Iran

4 Department of Microbiology, Zanjan Branch, Islamic Azad University, Zanjan, Iran

5 Department of Pathobiology, Science and Research Branch, Islamic Azad University, Tehran, Iran

6 HIV/AIDS Research Center, Fasa University of Medical Sciences, Fasa, Iran



Background and Purpose: Vulvovaginal candidiasis (VVC) is an opportunistic
infection due to Candida species, one of the most common genital tract diseases among reproductive-age women. The present study aimed to investigate the prevalence of VVC among non-pregnant women and identify the epidemiology of the involved Candida species with the evaluation of antifungal susceptibilities.
Materials and Methods: Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) was performed to identify Candida species isolated from the genital tract of 350 non-pregnant women. Moreover, antifungal susceptibility testing was performed according to the Clinical and Laboratory Standards Institute broth microdilution method guidelines (M27-A3 and M27-S4).
Results: Vaginal swab cultures of 119 (34%) women yielded Candida species. Candida
albicans was the most frequently isolated species (68%), followed by Candida glabrata
(19.2%). Voriconazole was the most active drug against all tested isolates showing an
MIC50/MIC90 corresponding to 0.016/0.25 µg/mL, followed by posaconazole (0.031/1
µg/mL). Overall, resistance rates to fluconazole, itraconazole, and voriconazole were
2.4%, 4.8% and, 0.8% respectively. However, posaconazole showed potent in vitro activity against all tested isolates.
Conclusion: Results of the current study showed that for the effectual therapeutic
outcome of candidiasis, accurate identification of species, appropriate source control,
suitable antifungal regimens, and improved antifungal stewardship are highly recommended for the management and treatment of infection with Candida, like VVC.