Antifungal susceptibility profiles of Candida and non- albicans s pecies isolated from pregnant women: implications for emerging antimicrobial resistance in maternal health

Abstract

Vulvovaginal candidiasis (VVC) is a common fungal infection, affecting approximately 75% of women at least once in their lifetime. Candida albicans is the predominant pathogen, responsible for 85%-90% of symptomatic cases. This study assessed the prevalence and antifungal susceptibility patterns of Candida species isolated from pregnant women with VVC to determine species-specific resistance trends and treatment implications. A cross-sectional study was conducted between November 2020 and July 2023 at Ho Teaching Hospital and Ho Municipal Hospital, the primary referral health facilities in the Volta Region. A total of 205 pregnant women across all trimesters participated. Vaginal swabs were collected and cultured for Candida species isolation and identification. Antifungal susceptibility of the isolates was assessed using the Kirby-Bauer disk diffusion method against clotrimazole (10 µg), fluconazole (10 µg), itraconazole (10 µg), and nystatin (100 IU). The prevalence of VVC among participants was 50.7%. C. albicans was most frequent (22.9%), followed by Candida krusei (14.1%), Nakaseomyces glabrata (9.3%), Candida tropicalis (2.4%), and Candida dubliniensis (2.0%). C. albicans exhibited high susceptibility to clotrimazole (87.2%) and nystatin (87.2%) but lower susceptibility to fluconazole (44.7%) and itraconazole (44.7%). Resistance was observed, particularly in C. dubliniensis to fluconazole (100%). The findings highlight the diversity of Candida species in VVC and the necessity of species-specific antifungal therapy. Laboratory diagnostics are critical to guide treatment and mitigate antifungal resistance. Routine surveillance and judicious antifungal use are vital to preventing resistance, while antenatal visits offer opportunities for education on VVC prevention and management.IMPORTANCEVulvovaginal candidiasis (VVC) is a common yeast infection that affects many women, especially during pregnancy. This study examined how often VVC occurs in pregnant women and how well different antifungal treatments work. The researchers who studied 205 pregnant women in Ho, Volta Region, Ghana, found that over half (50.7%) had VVC. The most common fungus was Candida albicans, but other types, such as Nakaseomyces glabrata and Candida krusei, were also present-and some were resistant to common antifungal drugs. While clotrimazole and nystatin were effective, many fungi were resistant to fluconazole and itraconazole medications, which are often used to treat infections. Since untreated VVC can lead to complications such as preterm birth, the study emphasizes the need for early testing and tailored treatments to prevent health risks, the importance of routine screenings during pregnancy, and better awareness about safe and effective antifungal treatments.

Keywords: Candida species; antenatal care; antifungal resistance; antifungal susceptibility; maternal health; pregnancy; vulvovaginal candidiasis.