, Volume 157, Issue 2, pp 163–169 | Cite as

Fluconazole and itraconazole susceptibility of vaginal yeast isolates from Slovakia

  • Monika Sojakova
  • Denisa Liptajova
  • Miroslav Borovsky
  • Julius Subik


Vulvovaginal candidiasis is a common mucosal infection caused by opportunistic yeasts of the Candida genus. In this study, we isolated and identified the yeast species in the vagina of patients treated in the gynecology clinic and tested in vitro activities of fluconazole and itraconazole against 227 clinical yeast isolates by the NCCLS microdilution method. C. albicans (87.6%) was the most frequently identified species followed by C. glabrata (6.2%) and C. krusei (2.2%). Almost thirteen percent of yeast strains were resistant to fluconazole and 18.5% were resistant to itraconazole. Cross-resistance analyses of C. albicans isolates revealed that fluconazole resistance and itraconazole resistance were also associated with decreased susceptibilities to other azole derivatives mainly to ketoconazole and miconazole. At the same time no cross-resistance to polyene antibiotics amphotericin B and nystatin was observed. These results support the notion that antifungal agents used to treat vaginitis may be contributing to the drug resistance problem by promoting cross-resistance to a range of clinically used antifungals.

Candida albicans C. glabrata drug resistance fluconazole itraconazole 


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  1. 1.
    Horowitz JB. Mycotic vulvovaginitis: A broad overview. Am J Obstet Gynecol 1991; 165: 1188–1192.PubMedGoogle Scholar
  2. 2.
    Mårdh PA, Rodrigues AG, Genc M, Novikova N, Martinez-de-Oliveira J, Guaschino S. Facts and myths on recurrent vulvovaginal candidosis — a review on epidemiology, clinical manifestation, diagnosis, pathogenesis and therapy. Int J STD & AIDS 2002; 13: 522–539.Google Scholar
  3. 3.
    Sanglard D, Ischer F, Calabrese D, Micheli M, Bille J. Multiple resistance mechanisms to azole antifungals in yeast clinical isolates. Drug Resist Updates 1998; 1: 255–265.Google Scholar
  4. 4.
    Ghannoum M, Rice LB. Antifungal agents: Mode of action, mechanisms of resistance, and correlation of these mechanisms with bacterial resistance. Clin Microbiol Rev 1999; 12: 501–517.PubMedGoogle Scholar
  5. 5.
    Kontoyiannis DP, Lewis RE. Antifungal drug resistance of pathogenic fungi. Lancet 2002; 359: 1135–1144.CrossRefPubMedGoogle Scholar
  6. 6.
    Al-Rawi N, Kavanagh K. Characterisation of yeasts implicated in vulvovaginal candidosis in Irish women. Br J Biomed Sci 1999; 56: 99–104.PubMedGoogle Scholar
  7. 7.
    Nyirjesy P, Seeney SM, Grody MHT, Jordan CA, Buckley HR. Chronic fungal vaginitis: The value of cultures. Am J Obstet Gynecol 1995; 173: 820–823.CrossRefPubMedGoogle Scholar
  8. 8.
    National Committee for Clinical Laboratory Standards (NCCLS). Publication M27-A: Reference method for broth dilution antifungal susceptibility testing of yeasts; approved standard. Wayne, PA: NCCLS, 1997; 17(9): 1–28.Google Scholar
  9. 9.
    Espinel-Ingroff A, Barchiesi F, Hazen KC, Martinez-Suarez JV, Scalise G. Standardization of antifungal susceptibility testing and clinical revelance. Med Mycology 1998; 36,Suppl I: 68–78.Google Scholar
  10. 10.
    Torrel-Rodriguez JM, Mendez R, Lopez-Jodra O, Morera Y, Espasa M, Jimenez T, Lagunas C. In vitro susceptibilities of clinical yeast isolates to the new antifungal eberconazole compared with their susceptibilities to clotrimazole and ketoconazole. Antimicrob Agents Chemotherap 1999; 43: 1258–1259.Google Scholar
  11. 11.
    Rodriguez-Tudela JL, Martin-Diez F, Cuenca-Estrella M, Rodero L, Carpintero Y, Gorgojo B. Influence of shaking on antifungal susceptibility testing of Cryptococcus neoformans: a comparison of the NCCLS standard M27A medium, buffered Yeast Nitrogen Base, and RPMI-2% glucose. Antimicrob Agents Chemotherap 2000; 44: 400–404.Google Scholar
  12. 12.
    Delaveau T, Delahodde A, Carvajal E, Subik J, Jacq C. PDR3, a new yeast regulatory gene, is homologous to PDR1 and controls the multidrug resistance phenomenon. Mol Gen Genet 1994; 244: 501–511.CrossRefPubMedGoogle Scholar
  13. 13.
    Rex JH, Pfaller MA, Galgiani JN, Barlett MS, Espinel-Ingroff A, Ghannoum MA, Lancaster M, Odds FC, Rinaldi MG, Walsh TJ, Barry AL. Development of interpretative breakpoints for antifungal susceptibility testing: conceptual framework and analysis of in vitro-in vivo correlation data for fluconazole, itraconazole, and Candida infections. Clin Infect Dis 1997; 24: 235–247.PubMedGoogle Scholar
  14. 14.
    Revankar SG, Kirkpatrick WR, McAtee RK, Fothergill AW, Redding SW, Rinaldi M G, Patterso, T. Interpretation of trailing endpoints in antifungal susceptibility testing by the National Committee for Clinical Laboratory Standards Method. J Clin Microb 1998; 36: 153–156.Google Scholar
  15. 15.
    Morschauser J. The genetic basis of fluconazole resistance development in Candida albicans. Biochim Biophys Acta 2002; 1587: 240–248.Google Scholar
  16. 16.
    Sobel JD. Limitation of antifungal agents in the treatment of Candida vaginitis: future challenges. Drug Resist Updates 1999; 2: 148–152.Google Scholar
  17. 17.
    Spinillo A, Capuzzo E, Gulminetti R, Marone P, Colonna L, Piazzi G. Prevalence of and risk factors for fungal vaginitis caused by non-albicans species. Am J Obstet Gynecol 1997; 176: 138–141.PubMedGoogle Scholar
  18. 18.
    Spinillo A, Capuzzo E, Acciano S, De Santolo A, Zara F. Effect of antibiotic use on the prevalence of symptomatic vulvovaginal candidiasis. Am J Obstet Gynecol 1999; 180: 14–17.CrossRefPubMedGoogle Scholar
  19. 19.
    Saporiti AM, Gomez D, Levalle S, Galeano M, Davel G, Vivot W, Rodero L. Vaginal candidiasis: etiology and sensitivity pro-file to antifungal agents in clinical use. Rev Argent Microbiol 2001; 33: 217–222.PubMedGoogle Scholar
  20. 20.
    Sobel JD. Vulvovaginitis due to Candida glabrata. An emerging problem. Mycoses 1998; 41: 18–22.PubMedGoogle Scholar
  21. 21.
    Riberio MA, Dietze R, Paula CR, Da Matta DA, Colombo AL. Susceptibility profile of vaginal yeast isolates from Brazil. Mycopathologia 2000; 151: 5–10.Google Scholar
  22. 22.
    Takada M, Kubota T, Hogaki M. Attributes of microorganisms that contribute to recurrence and intractability of vulvovaginal mycosis. Acta Obstet Jpn 1986; 38: 1125–1134.Google Scholar
  23. 23.
    Redondo-Lopez V, Lynch M, Schmitt C, Cook R, Sobel JD. Torulopsis glabrata vaginitis: clinical aspects and susceptibility to antifungal agents. Obstet Gynecol 1990; 76: 651–654.PubMedGoogle Scholar
  24. 24.
    Cross EW, Park S, Perlin DS. Cross-resistance of clinical isolates of Candida albicans and Candida glabrata to over-the-counter azoles used in the treatment of vaginitis. Microb Drug Resist 2000; 6: 155–161.CrossRefPubMedGoogle Scholar
  25. 25.
    Candido RC, Toloi MRT, Franceschini SA, Garcia FR, Minto ECM. In vitro activity of antimycotic agents determined by E-test method against vaginal Candida species. Mycopathologia 1999; 144: 15–20.Google Scholar
  26. 26.
    Vasquez JA, Peng G, Sobel JD, Steele-Moore L, Schuman P, Holloway W, Neaton JD. Evolution of antifungal susceptibility among Candida species isolates from human immunodeficiency virus-infected women receiving fluconazole prophylaxis. Clin Infect Dis 2001; 33: 1069–1075.Google Scholar
  27. 27.
    Saporiti AM, Gomez D, Levalle S, Galeano M, Davel G, Vivot W, Rivero L. Vaginal candidiasis: etiology and sensitivity pro-file to antifungal agents in clinical use. Rev Argent Microbiol 2001; 33: 217–222.PubMedGoogle Scholar
  28. 28.
    Johnson EM, Warnock DW, Lucker J, Porter SR, Scully C. Emergence of azole drug resistance in Candida from HIV-infected patients receiving prolonged fluconazole therapy for oral candidosis. J Antimicrob Chemother 1995; 35: 103–114.PubMedGoogle Scholar
  29. 29.
    El-Dinn SS, Reynolds MT, Ashbee HR, Barton RC, Evans EG. An investigation into the pathogenesis of vulvovaginal candidosis. Sex Transm Infect 2001; 77: 179–183.Google Scholar

Copyright information

© Kluwer Academic Publishers 2004

Authors and Affiliations

  • Monika Sojakova
    • 1
  • Denisa Liptajova
    • 2
  • Miroslav Borovsky
    • 1
  • Julius Subik
    • 2
  1. 1.1st Department of Obstetrics and Gynecology, Faculty of MedicineComenius UniversityBratislavaSlovak Republic
  2. 2.Department of Microbiology and Virology, Faculty of Natural SciencesComenius UniversityBratislavaSlovak Republic

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