# Antifungal Testing of Vaginal Candida Isolates in Pregnant Women: A Retrospective, Single-Center Study in Adana, Türkiye

## TL;DR

This study tested how well different antifungals work against vaginal Candida isolates in pregnant women in Türkiye, highlighting the importance of pH and strain type for treatment decisions.

## Contribution

The study compares antifungal susceptibility in different Candida strains from pregnant women and emphasizes the importance of pH and strain classification for reliable testing.

## Key findings

- Topical antifungals like miconazole, nystatin, and clotrimazole showed strong activity at pH 4 for treating Candida vaginitis in pregnant women.
- C. glabrata petite isolates had 2–5 times higher MIC values than non-petite isolates for fluconazole and itraconazole.
- Disk diffusion and broth microdilution methods showed differing results, emphasizing the need for reliable susceptibility testing.

## Abstract

Clinical and mycological data are essential for the optimal management of patients with Candida vaginitis (CV), particularly in cases of (i) azole-resistant C. albicans vaginitis, (ii) recurrent CV, and (iii) CV in pregnant women. The present retrospective single-center study investigated the antifungal activity of six commonly used antifungals against randomly selected vaginal isolates recovered from 68 pregnant women in Adana, Türkiye, including C. albicans, petite C. glabrata, non-petite C. glabrata, and C. krusei, using the disk diffusion method at pH 4 and 7. Furthermore, the antifungal activities of fluconazole and itraconazole were also assessed using the broth microdilution method. For all isolates, the mean inhibition zone diameters were narrower for itraconazole and ketoconazole and larger for miconazole at pH 4 than pH 7 (p < 0.05). For nystatin, zone diameters were wider in C. albicans and petite C. glabrata at pH 4 (p < 0.001 and p < 0.001). Remarkably, clotrimazole was more active at pH 4 than at pH 7, except against non-petite C. glabrata isolates. Based on the broth microdilution results, the resistance rate was higher at pH 4 than at pH 7 in all isolates. Candida glabrata petite isolates exhibited MIC values 2 to 5 times higher than those of the non-petite isolates for both fluconazole and itraconazole. This study highlights the potent activity of topical antifungals (miconazole, nystatin, and clotrimazole) for the treatment of CV in pregnant women and highlights the need to identify petite and non-petite mutants of vaginal C. glabrata isolates to obtain more reliable data and for antifungal susceptibility testing prior to decision-making. The results of the two antifungal susceptibility methods were compared for C. albicans and C. glabrata isolates, and the reliability of the disk diffusion test was discussed.