Prevalence and species distribution of microorganisms isolated among non-pregnant women affected by vulvovaginal candidiasis: A retrospective study over a 20 year-period

Background: Vulvovaginal candidiasis (VVC) is the second most common infection of the genital tract affecting millions of women worldwide. Data concerning the distribution and antifungal resistance of Candida species responsible of VVC vary among countries and population studied. Objectives: The aim of this work was to determine the prevalence, species distribution and antifungal susceptibility patterns of Candida species among symptomatic women over a 20-year period. Methods: A total of 5,820 unique samples were retrospectively identified. Out of them, 1,046 (18%) were diagnosed with VVC. Results: Women between 18 and 30 years had the highest prevalence rate of VVC (21%). Women aged less than 18 years and greater than 51 years had the highest prevalence rates of vaginal bacterial infections. Thirty-five (3.3%) women presented recurrent VVC. The most common yeast isolated was C. albicans, followed by C. glabrata, C. krusei, and C. parapsilosis. Non-Candida albicans species (NAC) were more significantly isolated among women aged 51 or above, than in women included in other groups (p < 0.01). Resistance to fluconazole and amphotericin B was infrequent in C. albicans strains. Resistance to fluconazole and amphotericin B was infrequent in C. albicans strains. NAC species presented higher resistance rates against fluconazole (30%) and voriconazole (25%). C. krusei and C. glabrata isolates showed lower MICs than most of the strains against amphotericin B (1 mg/L) and flucytosine (1 mg/L). Conclusions: Our findings indicated that continued surveillance on Candida species distribution and non-susceptibility rates to antifungals should be routinely reported to help the selection of the most appropriate drug, to avoid the emergence of resistant strains, and to improve the patient's outcomes.