Resistant C. albicans implicated in recurrent vulvovaginal candidiasis (RVVC) among women in a tertiary healthcare facility in Kumasi, Ghana

• Published in: BMC women's health Vol. 24; no. 1; pp. 412 - 11
• Main Authors: Sarpong, Abena Kyeraa, Odoi, Hayford, Boakye, Yaw Duah, Boamah, Vivian Etsiapa, Agyare, Christian
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 19-07-2024; BioMed Central; BMC
• Subjects: Adolescent; Adult; Amphotericin B - pharmacology; Amphotericin B - therapeutic use; Antibiotics; Antifungal agents; Antifungal Agents - pharmacology; Antifungal Agents - therapeutic use; Antifungal susceptibility; Antimicrobial agents; Candida albicans; Candida albicans - drug effects; Candida albicans - isolation & purification; Candidiasis, Vulvovaginal; Candidiasis, Vulvovaginal - drug therapy; Candidiasis, Vulvovaginal - epidemiology; Candidiasis, Vulvovaginal - microbiology; Demographic aspects; Development and progression; Dosage and administration; Drug resistance; Drug Resistance, Fungal; Drug therapy; Female; Females; Ghana - epidemiology; Gynecology; Health facilities; Humans; Infections; Microbial Sensitivity Tests; Middle Aged; Obstetrics; Organisms; Patient outcomes; Personal hygiene; Polymerase chain reaction; Questionnaires; Recurrence; Recurrent vulvovaginal candidiasis; Reproductive health; Risk Factors; Teaching hospitals; Tertiary Care Centers - statistics & numerical data; Vagina; Vagina - microbiology; Womens health; Women’s health; Yeast; Yeasts; Young Adult; Ghana; Asia; Europe; Candida albicans; Antifungal susceptibility; Recurrent vulvovaginal candidiasis; Women’s health
• ISSN: 1472-6874; 1472-6874
• DOI: 10.1186/s12905-024-03217-6

Vulvovaginal candidiasis is a common fungal infection that affects the female lower genital tract. This study determined the major risk factors associated with vulvovaginal infection (VVI) in the Ashanti region of Ghana and also determined the antifungal resistance patterns of Candida albicans isolates to some antifungals.
Three hundred and fifty (350) high vaginal swab (HVS) samples were collected from women who presented with signs and symptoms of VVI. A structured questionnaire was administered to one hundred and seventy-two (172) of the women. HVS samples were cultured on Sabouraud dextrose agar with 2% chloramphenicol. The polymerase chain reaction was employed to confirm C. albicans. Antifungal susceptibility testing was performed and the susceptibility of C. albicans isolates to fluconazole, clotrimazole, amphotericin B, nystatin, miconazole and 5-flurocytosine were assessed.
Vaginal infection was most prevalent amongst females in their reproductive age (21 to 30 years; 63.0%). The study found a significant association between vaginal infections and some risk factors such as sexual practices (p < 0.001), antibiotic misuse (p < 0.05), poor personal hygiene (p < 0.005) and birth control methods (p < 0.049). Out of the 350 HVS samples collected, 112 yielded yeast cells with 65 (58%) identified as C. albicans. The C. albicans isolates were resistant to 5' flucytosine (100%), fluconazole (70%), voriconazole (69.2%), miconazole (58.5%) and nystatin (49.2%). C. albicans isolates were more susceptible to amphotericin B (53.8%) and clotrimazole (45.1%), although an appreciable number of isolates showed resistance (46.1% and 52.3%, respectively).
There should be nationwide education on all associated risk factors of VVI. Also, use of the various antifungal agents in vaginal candidiasis should proceed after antifungal susceptibility testing to ensure efficacious use of these agents.