Antifungal resistance profile in the treatment of vaginal candidiasis: A diagnosis of etiologic agents
Keywords:
Vulvovaginal candidiasis, Candida albicans, Candida glabrata, azoles, fluconazole, resistance.Abstract
Introduction: In mycoses, resistance to antifungals increases due to incorrect diagnosis and treatment. Therefore, surveillance and monitoring of resistant strains has been suggested to ensure adequate therapy.
Objective: To determine the Candida species and the resistance profile to fluconazole and voriconazole presented by the isolates obtained from samples stored during the months of December 2017 and March 2018 from patients coming from the Laboratory of the Regional Hospital "Miguel Ángel Mariscal Llerena" in the department of Ayacucho, Peru.
Material and Methods: Cross-sectional descriptive study in which 110 strains of Candida sp were isolated and stored for a period of four (04) months, and processed by standardized methods approved by the Ministry of Health (MINSA) and the National Institute of Health (INS) of Peru related to the diagnosis of etiological agents of human mycosis and antifungal sensitivity with the standardized methods of the Clinical Laboratory Standard Institute (CLSI).
Results: C. albicans was observed in 86,4 % of isolates, followed by C. glabrata (9,1 %), C. parapsilosis (2,7 %), and 0,9 % of C. tropicalis and C. krusei; 10,5 % of C. albicans was resistant to fluconazole and voriconazole with MIC ≥ 128 μg/mL and ≥ 16 μg/mL respectively, while 20 % of C. glabrata showed dose dependent sensitivity and 10 % resistance to fluconazole.
Conclusions: There is a wide variety of Candida species, with C. albicans being the most common, followed by C. glabrata, with a higher percentage of isolation compared to other species. It can be seen that these species have considerable degrees of vulnerability to the application of drugs such as fluconazole and voriconazole.
Downloads
References
1. Nagashima M, Yamagishi Y, Mikamo H. Antifungal susceptibilities of Candida species isolated from the patients with vaginal candidiasis. J Infect Chemother [Internet]. 2016;22(2):124-6. Disponible en: http://dx.doi.org/10.1016/j.jiac.2015.08.008
2. Zeng X, Zhang Y, Zhang T, Xue Y, Xu H, An R. Risk factors of vulvovaginal candidiasis among women of reproductive age in Xi’an: a cross-sectional study. Biomed Res Int [Internet]. 2018;9703754. Disponible en: https://doi.org/10.1155/2018/9703754
3. Menz ML, Calil LN, Bittencourt FM, Mezzari A. Atenção farmacêutica no contexto de um Projeto de Extensão com vistas ao atendimento de pacientes com candidíase vaginal tendo como estratégia realizar o teste de resistência aos antifúngicos e a prevenção da saúde comunitária. Sci Elec Arch [Internet]. 2020;13(9):91-8. Disponible en: http://dx.doi.org/10.36560/13920201073
4. Vieira AJH, Santos JI. Mecanismos de resistência de Candida albicans aos antifúngicos anfotericina B, fluconazol e caspofungina. RBAC [Internet]. 2017 [Citado 28/10/2020];49(3):235-9. Disponible en: https://bit.ly/34zQzje
5. Cassone A, Sobel JD. Experimental models of vaginal candidiasis and their relevance to human candidiasis. Infect Immun [Internet]. 2016;84:1255-61. Disponible en: https://doi.org/10.1128/IAI.01544-15.
6. Durango Chávez OK, Mejía Delgado EM. Comparación del efecto in vitro de los aceites esenciales de Eucalyptus globulus y Origanum vulgare sobre Candida albicans aislada de paciente con candidiasis vulvovaginal. Rev méd Trujillo [Internet]. 2020;15(1):11-25. Disponible en: http://dx.doi.org/10.17268/rmt.2020.v15i01.03
7. Bhattacharya S, Sae Tia S, Fries BC. Candidiasis and Mechanisms of Antifungal Resistance. Antibiotics [Internet]. 2020;9(6):312-31. Disponible en: https://doi.org/10.3390/antibiotics9060312
8. Martínez Pizarro S. Ajo para el tratamiento de la candidiasis vaginal. Rev Chil Obstet Ginecol [Internet]. 2020;85(4):310-1. Disponible en: http://dx.doi.org/10.4067/S0717-75262020000400310
9. Martens MG. Patient preferences in the treatment of vaginal candidiasis. Open J Obstet Gynecol [Internet]. 2018;8:1147-55. Disponible en: https://doi.org/10.4236/ojog.2018.812116
10. Lirio J, Giraldo PC, Amaral RL, Alves Sarmiento AC, Ferreira Costa AP, Gonçalves AK. Antifungal (oral and vaginal) therapy for recurrent vulvovaginal candidiasis: a systematic review protocol. BMJ Open [Internet]. 2019;9:e027489. Disponible en: https://doi.org/10.1136/bmjopen-2018-027489
11. Nagashima M, Yamagishi, Y, Mikamo H. Antifungal susceptibilities of Candida species isolated from the patients with vaginal candidiasis. J Infect Chemother [Internet]. 2016; 22(2):124-6. Disponible en: http://dx.doi.org/10.1016/j.jiac.2015.08.008
12. Thamkhantho M, Chayachinda C. Vaginal tablets of dequalinium chloride 10 mg versus clotrimazole 100 mg for vaginal candidiasis: a double-blind, randomized study. Arch Gynecol Obstet [Internet]. 2020;303(1):151-60 Disponible en: http://dx.doi.org/10.1007/s00404-020-05784-z
13. Miró MS, Rodríguez E, Vigezzi C, Icely PA, Gonzaga M, Riera FO, et al. Candidiasis vulvovaginal: una antigua enfermedad con nuevos desafíos. Rev Iberoam Micol [Internet]. 2017;34:65-71. Disponible en: http://dx.doi.org/10.1016/j.riam.2016.11.006.
14. Zurita Macalupú S, Urcia Ausejo F, Navarro
Mariñas A. Manual de procedimientos técnicos para el diagnóstico micológico [Internet]. Lima: Ministerio de Salud, Instituto Nacional de Salud; 2017 [Citado 28/10/2020]. Disponible en: https://antimicrobianos.ins.gob.pe/images/contenido/documentos/nacionales/MANUAL_DE_PROCEDIMIENTOS_MICOLOGICOS_INS_PERU.pdf
15. Guevara Robles M, Urcia Ausejo F, Casquero Cavero J.
Manual de procedimientos y técnicas de laboratorio para la identificación
de los principales hongos oportunistas causantes de micosis humanas [Internet]. Lima: Ministerio de Salud, Instituto Nacional de Salud; 2007 [Citado 28/10/2020]. Disponible en: https://bvs.ins.gob.pe/insprint/SALUD_PUBLICA/NOR_TEC/44.pdf
16. Cantón E, Martín E, Espinel Ingroff A. Métodos estandarizados por el CLSI para el estudio de la sensibilidad a los antifúngicos (documentos M27-A3, M38-A, M44-A) [Internet]. España: Asociación Española de Micología; 2007 [Citado 28/10/2020]. Disponible en: http://www.guia.reviberoammicol.com/Capitulo15.pdf
17. Zurita Macalupú S. Situación de la resistencia antifúngica de especies del género Candida en Perú. Rev Peru Med Exp Salud Publica [Internet]. 2018;35(1):126-31. Disponible en: http://dx.doi.org/10.17843/rpmesp.2018.351.3563
18. Díaz MC, Camponovo R, Araya I, Cerda A, Santander MP, Carrillo Muñoz AJ. Identificación y sensibilidad antifúngica in vitro de Candida spp. de origen vaginal a fluconazol, clotrimazol y nistatina. Rev Esp Quimioter [Internet]. 2016 [Citado 28/10/2020]; 29(3):151-4. Disponible en: https://bit.ly/31ZunNU
19. Perurena Lancha M, Pérez Muñoz Y, Fernández Andreu CM, Martínez Machín G, Illnait Zaragozí MT. Susceptibilidad antifúngica de aislados vaginales de Candida spp. Rev Cubana Med Trop [Internet]. 2016 [Citado 28/10/2020];68(3):248-54. Disponible en: https://bit.ly/37YSNL6
20. Rodríguez L, Bustamante B, Huaroto L, Agurto C, Illescas R, Ramirez R, et al. A multi-centric Study of Candida bloodstream infection in Lima-Callao, Peru: Species distribution, antifungal resistance and clinical outcomes. PLoS One [Internet]. 2017;12(4): e0175172. Disponible en: https://doi.org/10.1371/journal.pone.0175172
21. Vázquez Zamora KG, Villalobos Barboza K, Vergara Espinoza MA, Ventura Flores R, Silva Díaz H. Frecuencia y susceptibilidad antifúngica de Candida spp. (no C. albicans) aislado de pacientes en unidades de cuidados intensivos de un hospital terciario en el norte de Perú. Horiz. Medicina [Internet]. 2020;20(4):e1230. Disponible en: http://dx.doi.org/10.24265/horizmed.2020.v20n4.06
22. Ávila KL, Rosado RD, Lugo Caballero CI, León JA, Castro JZ. Mecanismos de resistencia antifúngica de los azoles en Candida albicans. Una revisión. Rev Biomédica [Internet]. 2016;27(3):127-36. Disponible en: https://doi.org/10.32776/revbiomed.v27i3.541
Download PDF
