Reduced Antifungal Susceptibility of Vulvovaginal Candida Species at Normal Vaginal pH Levels: Clinical Implications

Journal of Lower Genital Tract Disease
Mark Spitzer, Nathan P Wiederhold

Abstract

The aims of the study were to assess for differences in antifungal in vitro potency at pH 7 and pH 4 and to discuss any potential clinical implications of that difference. A retrospective analysis of 217 first positive yeast cultures from 217 patients. Yeast isolates underwent antifungal susceptibility testing, with minimum inhibitory concentrations (MICs) (microgram per milliliter) measured at pH 7 and pH 4 for fluconazole, itraconazole, miconazole, clotrimazole, terconazole, and nystatin. Only the first isolates collected from each patient were included in the analysis. Yeast first isolates included 173 Candida albicans, 15 Candida glabrata, and 29 isolates from 8 other species. Geometric mean (GM) MIC values for all antifungals were significantly higher when tested at pH 4 (p < .001 for all comparisons). For C. albicans, the largest GM MIC differences were observed for terconazole (0.17 pH 7 vs 6.17 pH 4) and clotrimazole (0.04 vs 0.24). For terconazole, 97.7% of the isolates had a MIC of 1 or less at pH 7 but 83.2% had a MIC of 4 or higher at pH 4. For C. glabrata, terconazole (GM MIC = 0.26 pH 7 vs >64 pH 4), clotrimazole (0.13 vs 6.96), miconazole (0.06 vs 0.76), and fluconazole (3.17 vs 26.6) were most affected. All C. g...Continue Reading

References

Apr 1, 1997·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·J D Sobel, W Chaim
Oct 18, 2002·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Shivani SinghJose A Vazquez
May 4, 2005·Infection Control and Hospital Epidemiology : the Official Journal of the Society of Hospital Epidemiologists of America·Keith S KayeYehuda Carmeli
May 6, 2005·Journal of Clinical Microbiology·Sandra S RichterMichael A Pfaller
Jun 15, 2007·Lancet·Jack D Sobel
Apr 24, 2010·Journal of Medical Microbiology·Rajendra J KothavadeM H Panthaki
Nov 6, 2010·Drug Resistance Updates : Reviews and Commentaries in Antimicrobial and Anticancer Chemotherapy·M A PfallerUNKNOWN CLSI Subcommittee for Antifungal Susceptibility Testing

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Citations

May 7, 2020·European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology·Ifeanyi Elibe Mba, Emeka Innocent Nweze
Sep 5, 2020·International Journal of STD & AIDS·Guideline Development Group Cara Saxon Lead AuthorMark FitzGerald Ceg Editor
Aug 25, 2021·Medical Mycology·Paula Faria-GonçalvesJoana Rolo

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