Epidemiologic Evaluation of Candida Species in Vaginal Swab Specimens: An 11-Year Retrospective Study

Abstract

Objective: Candida species may be part of the normal vulvovaginal flora, and hence their isolation in vaginal cultures does not necessarily indicate infection. However, vulvovaginal candidiasis (VVC) is a clinical condition particularly prevalent among women of reproductive age. The aim of this study was to investigate the epidemiology of Candida species isolated from vaginal swab samples (VSS) in the microbiology laboratory. Materials and Methods: This study was designed retrospectively at a university hospital in Istanbul, with a bed capacity of 950, between August 2012 and August 2023. A total of 7050 vaginal swab culture results were analyzed in the microbiology laboratory. VSSs were cultured on CHROMagar™ Candida (CHROMagar, Paris, France) to isolate fungal pathogens. Automated systems such as the VITEK 2 (bioMérieux, France) system or MALDI-TOF mass spectrometry (Bruker, United States) were employed for undetermined colonies on this medium. The study evaluated the results of 2594 vaginal swab cultures and identified Candida species.  Results: The rate of Candida species in VSS cultures was 36.79%. The mean age of the patients was 36.1 years (range: 0–85 years), with 97.8% falling within the category of young adults. The highest prevalence of VVC was in patients 29–38 years of age (48%). Candida albicans accounted for 70.7%, non-albicans Candida for 26.4%, and growth of more than one Candida species for 2.8%. The most frequently observed non-albicans species was Candida glabrata, accounting for 23.1% of the isolates. Conclusions: C. albicans was the predominant species in VSSs. However, the emergence of C. glabrata as a significant non-albicans species is a serious concern due to its potential for azole resistance.

Keywords

• Candida albicans
• non-albicans Candida
• vaginal candidiasis
• vaginal swab culture

Vajinal Sürüntü Örneklerindeki Candida Türlerinin Epidemiyolojik Değerlendirmesi: 11 Yıllık Retrospektif Bir Çalışma

Öz

Amaç: Candida türleri normal vulvovajinal floranın bir parçası olabilir ve bu nedenle vajinal kültürlerde izole edilmeleri mutlaka enfeksiyona işaret etmez. Bununla birlikte, vulvovajinal kandidiyazis özellikle üreme çağındaki kadınlarda yaygın olan klinik bir durumdur. Bu çalışmanın amacı, mikrobiyoloji laboratuvarına gönderilen vajinal sürüntü kültürlerinden izole edilen Candida türlerinin epidemiyolojisini incelemektir. Materyal ve Metot: Bu çalışma Ağustos 2012-Ağustos 2023 tarihleri arasında İstanbul'da 950 yatak kapasiteli bir üniversite hastanesinde retrospektif olarak gerçekleştirilmiştir. Toplam 7050 vajinal sürüntü örneği kültürü mikrobiyoloji laboratuvarında analiz edilmiştir. Mantar patojenlerinin izolasyonu için kültür besiyeri olarak CHROMagar™ Candida (CHROMagar, Paris, France) kullanılmıştır. Bu besiyerinde belirlenemeyen kolonilerin tanımlanması için VITEK 2 (bioMérieux, Fransa) sistemi veya MALDI-TOF mass spectrometry (Bruker, United States) gibi otomatize sistemler kullanılmıştır. Çalışmada, Candida türlerinin tanımlandığı 2594 vajinal sürüntü kültürünün sonuçları değerlendirilmiştir. Bulgular: Vaginal sürüntü kültürlerinden Candida türlerinin izolasyon oranı %36.79’dır. Hastaların ortalama yaşı 36.1 (aralık: 0-85 yıl) olup, %97.8'i genç yetişkin kategorisinde yer almaktadır. En yüksek vulvovaginal kandidiyazis prevalansı 29-38 yaş arasındaki hastalarda görülmüştür (%48). Candida albicans %70,7, non-albicans Candida %26.4 ve birden fazla türde Candida üremesi %2.8 oranında görülmüştür. En sık gözlenen non-albicans Candida türü, izolatların %23.1'ini oluşturan Candida glabrata olmuştur. C. albicans ve non-albicans Candida izolasyon oranlarında çalışma periyodu süresince anlamlı bir değişiklik gözlenmemiştir. Sonuç: On bir yıllık süreçte C. albicans vajinal sürüntü örneklerinde baskın tür olarak kalmıştır. Bununla birlikte non-albicans Candida türlerinden C. glabrata'nın baskın tür olarak ortaya çıkması, azol direnci potansiyeli nedeniyle tedavi güçlüğü açısından endişe kaynağıdır.

Anahtar Kelimeler

• Candida albicans
• non-albicans Candida
• vajinal kandidiyazis
• vajinal sürüntü kültürü

Kaynakça

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