Fluconazole-Resistant Candida albicans Vaginal Infections at a Referral Center and Treated With Boric Acid.
Journal
Journal of lower genital tract disease
ISSN: 1526-0976
Titre abrégé: J Low Genit Tract Dis
Pays: United States
ID NLM: 9704963
Informations de publication
Date de publication:
01 Jul 2023
01 Jul 2023
Historique:
medline:
30
6
2023
pubmed:
25
3
2023
entrez:
24
3
2023
Statut:
ppublish
Résumé
The authors investigate the incidence of clinical and mycological resistance of Candida albicans vulvovaginitis (VVC) at the Jefferson Vulvovaginal Health Center. They also review their experience with boric acid in the treatment of fluconazole-resistant VVC. The authors conducted a retrospective chart review of all patients with C. albicans VVC diagnosed at the Jefferson Vulvovaginal Health Center between November 2019 and December 2021. Patients with clinically defined fluconazole resistance were identified. Information about demographics, in vitro susceptibility testing, and treatment outcomes with boric acid was obtained. Of 970 patients with vaginal C. albicans isolates, 71 (7.3%) with clinically defined fluconazole-resistant C. albicans infections were identified. Relevant demographics included 45.1% African American, 43.7% aged younger than 30 years, and 43.7% with body mass index less than 25. Of the 71 patients, 58 (81.7%) received vaginal boric acid treatment. The mycological and clinical cure rates were 85.7% and 73.7%, respectively. After successful boric acid treatment and negative yeast cultures, 14.3% of patients had a mycological recurrence within 3 months. Of 31 isolates with antifungal susceptibility testing, 83.9% (26/31) were found to have minimal inhibitory concentration results consistent with fluconazole resistance. In a tertiary care vulvovaginal health center, fluconazole-resistant Candida albicans VVC is by no means uncommon and usually responds in the short term to treatment with boric acid. However, in the absence of maintenance boric acid, recurrence of culture-positive VVC is likely.
Identifiants
pubmed: 36961480
doi: 10.1097/LGT.0000000000000733
pii: 00128360-202307000-00015
doi:
Substances chimiques
Fluconazole
8VZV102JFY
Antifungal Agents
0
boric acid
R57ZHV85D4
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
262-265Informations de copyright
Copyright © 2023, ASCCP.
Déclaration de conflit d'intérêts
R.S. serves as a consultant for Scynexis Inc and Mycovia Pharmaceuticals. P.N. serves as a consultant for Scynexis Inc, Mycovia Pharmaceuticals, and Hologic Inc. The other authors have declared they have no conflicts of interest.
Références
Jeanmonod R, Jeanmonod D. Vaginal candidiasis. In: StatPearls . Treasure Island: StatPearls Publishing; 2021.
Sobel JD. Candidal vulvovaginitis. Clin Obstet Gynecol 1993;36:153–65.
Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021;70:1–187.
Shahid Z, Sobel JD. Reduced fluconazole susceptibility of Candida albicans isolates in women with recurrent vulvovaginal candidiasis: effects of long-term fluconazole therapy. Diagn Microbiol Infect Dis 2009;64:354–6.
Kukurudz RJ, Chapel M, Wonitowy Q, et al. Acquisition of cross-azole tolerance and aneuploidy in Candida albicans strains evolved to posaconazole. G3 (Bethesda) 2022;12:jkac156.
Sobel JD, Sobel R. Current treatment options for vulvovaginal candidiasis caused by azole-resistant Candida species. Expert Opin Pharmacother 2018;19:971–7.
Khosravi Rad K, Falahati M, Roudbary M, et al. Overexpression of MDR-1 and CDR-2 genes in fluconazole resistance of Candida albicans isolated from patients with vulvovaginal candidiasis. Curr Med Mycol 2016;2:24–9.
Mittelstaedt R, Kretz A, Levine M, et al. Data on safety of intravaginal boric acid use in pregnant and nonpregnant women: a narrative review. Sex Transm Dis 2021;48:e241–7.
Berkow EL, Lockhart SR. Fluconazole resistance in Candida species: a current perspective. Infect Drug Resist 2017;10:237–45.
Marchaim D, Lemanek L, Bheemreddy S, et al. Fluconazole-resistant Candida albicans vulvovaginitis. Obstet Gynecol 2012;120:1407–14.
Maebashi K, Niimi M, Kudoh M, et al. Mechanisms of fluconazole resistance in Candida albicans isolates from Japanese AIDS patients. J Antimicrob Chemother 2001;47:527–36.
Gamal A, Chu S, McCormick TS, et al. Ibrexafungerp, a novel oral triterpenoid antifungal in development: overview of antifungal activity against Candida glabrata . Front Cell Infect Microbiol 2021;11:642358.
Davis MR, Donnelley MA, Thompson GR. Ibrexafungerp: a novel oral glucan synthase inhibitor. Med Mycol 2020;58:579–92.
Sobel JD, Borroto-Esoda K, Azie N, et al. In Vitro pH activity of ibrexafungerp against fluconazole-susceptible and -resistant Candida isolates from women with vulvovaginal candidiasis. Antimicrob Agents Chemother 2021;65:e0056221.
Iavazzo C, Gkegkes ID, Zarkada IM, et al. Boric acid for recurrent vulvovaginal candidiasis: the clinical evidence. J Womens Health 2011;8:1245–55.
Salama OE, Gerstein AC. Differential Response of Candida Species Morphologies and Isolates to Fluconazole and Boric Acid. Antimicrob Agents Chemother 2022;66:e0240621.