Fluconazole-Resistant Candida albicans Vulvovaginitis
Abstract
OBJECTIVE: As a result of high recurrence rates of Candida albicans vaginitis, successful suppressive fluconazole is widely used, and drug resistance is considered rare. We report increased occurrence of secondary fluconazole resistance, analysis of risk factors thereof, and describe management of fluconazole-refractory vaginitis. METHODS: Patients referred to the Vaginitis Clinic at Wayne State University with clinically refractory fluconazole-resistant (minimum inhibitory concentration [MIC] 2 micrograms/mL or greater) C albicans vaginitis from 2000 to 2010 were enrolled. Patients completed a questionnaire pertaining to demographics, comorbidities, behavioral characteristics, exposure to antimicrobials and antifungals, fluconazole consumption in defined daily doses in the previous 6 months, management received, and outcomes. With patients not located, data were extracted from charts. Susceptibilities to antifungals were determined by broth microdilution. RESULTS: Twenty-five women with fluconazole-resistant recurrent C albicans vaginitis were identified, and 16 returned filled questionnaires. Study cohort consisted mainly of married, insured white women with more than 12 years of formal education and average or above average socioeconomic status. Median fluconazole MIC was 8 micrograms/mL (range 2-128 micrograms/mL). Risk factors for mycologic failure included increased fluconazole consumption (P=.03) with 16 of 25 women exposed to low-dose weekly fluconazole maintenance therapy. All patients were clinically controlled successfully, although treatment was difficult and often prolonged. CONCLUSION: Fluconazole-resistant C albicans vaginitis was previously considered rare. We report 25 cases over an 11-year period, indicating an emerging problem. All patients had fluconazole consumption in the previous 6 months. Management of fluconazole refractory disease is extremely difficult with limited options, and new therapeutic modalities are needed.
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Breakthrough infections are still relatively rare (usually <5% of patients).
“Although breakthrough infections are still relatively rare (usually < 5% of patients), in vitro susceptibility testing can be useful in selecting subsequent treatment.11,18”
From Clinical challenges in diagnosis and treatment of recurrent vulvovaginal candidiasis (2022) · cites this paper as [18]
In vitro susceptibility testing can be useful in selecting subsequent treatment.
“in vitro susceptibility testing can be useful in selecting subsequent treatment.11,18”
From Clinical challenges in diagnosis and treatment of recurrent vulvovaginal candidiasis (2022) · cites this paper as [18]
Repeated use of fluconazole increases risk for the development of resistant strains.
“Repeated use of fluconazole also increases risk for the development of resistant strains.13,18,26”
From Clinical challenges in diagnosis and treatment of recurrent vulvovaginal candidiasis (2022) · cites this paper as [18]
Almost all women diagnosed with resistant C. albicans strains had previously been exposed to fluconazole.
“In line with this, epidemiological data confirm that almost all women diagnosed with resistant C. albicans strains had previously been exposed to fluconazole (Marchaim et al., 2012).”
From Management of recurrent vulvovaginal candidosis: Narrative review of the literature and European expert panel opinion (2022) · cites this paper as Marchaim et al., 2012
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Self-citation
- Authors
- Marchaim, D., Lemanek, L., Bheemreddy, S., Kaye, K. S., & Sobel, J. D.
- Affiliations
- Wayne State University (US)
- Venue
- Obstetrics & Gynecology
- Published
- 2012-12
- Volume
- 120
- Issue
- 6
- Pages
- 1407-1414
- ISSN
- 0029-7844 (ISSN-L)
- OpenAlex
- W2185069069
- Cited by
- 195
- References
- 2
- Citations by year
- 2025: 10 · 2024: 16 · 2023: 19 · 2022: 28 · 2021: 19 · 2020: 20 · 2019: 11 · 2018: 17 · 2017: 18 · 2016: 5 · 2015: 12 · 2014: 13 · 2013: 4 · 2012: 2
- FWCI
- 6.85
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
- Health Sciences › Medicine › Ophthalmology › Ocular Infections and Treatments
- Keywords
- fluconazole resistance, Candida albicans, vulvovaginitis, recurrent vaginitis, risk factors, antifungal susceptibility, treatment failure
- MeSH terms
- Adult, Antifungal Agents, Candida albicans, Candidiasis, Vulvovaginal, Female, Humans, Microbial Sensitivity Tests, Middle Aged, Fluconazole, Incidence, Prevalence, Treatment Outcome, Drug Resistance, Fungal
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