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Background <p>Non-albicans Candida (NAC) species are increasingly implicated in vulvovaginal candidiasis (VVC) and are frequently associated with reduced susceptibility to commonly used azole antifungals. In sub-Saharan Africa, empirical azole therapy remains widespread despite limited local resistance data. This study aimed to determine the species distribution and antifungal susceptibility patterns of NAC isolates among women presenting with abnormal vaginal discharge in Western Uganda.</p> Methods <p>we conducted a hospital-based cross-sectional study among 314 women aged 18–49 years attending Mubende Regional Referral Hospital between May and August 2025. High vaginal swabs were cultured on Sabouraud Dextrose Agar, and Candida species were identified using CHROMagar™ Candida. Antifungal susceptibility testing was performed using the disc diffusion method for fluconazole, clotrimazole, miconazole, and amphotericin B, while caspofungin susceptibility was determined using the E-test. Results were interpreted according to established laboratory standards.</p> Results <p>Non-albicans Candida species were isolated in 23.6% (74/314) of participants. <i>Candida glabrata</i> was the predominant species (41.9%), followed by C. tropicalis (29.7%) and C. krusei (18.9%). Overall resistance to fluconazole was high (82.4%), with particularly elevated resistance among C. tropicalis (95.5%) and C. krusei (85.7%). Resistance to clotrimazole was observed in 52.7% of isolates. All NAC isolates demonstrated complete susceptibility to amphotericin B and caspofungin.</p> Conclusions <p>Non-albicans Candida species causing VVC in this setting exhibit alarmingly high resistance to azole antifungals, undermining the effectiveness of standard empirical therapy. Routine species identification and antifungal susceptibility testing, alongside strengthened antifungal stewardship, are urgently required to guide appropriate management in resource-limited settings.</p>

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High azole resistance among non-albicans Candida species causing vulvovaginal candidiasis in Western Uganda: a cross-sectional study

  • 期刊论文

  • 发表日期：

    2026年3月23日

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  • Suleiman Ameir Idrissa,
  • Marie Pascaline Sabine Ishimwe,
  • Musa Kasujja,
  • Theodore Nteziyaremye,
  • Sara Liban,
  • Yasmin Abdirashid Osman,
  • Kasiita Shem,
  • Maxwell Okello,
  • Rogers Kajabwangu,
  • Theoneste Hakizimana

摘要

Background

Non-albicans Candida (NAC) species are increasingly implicated in vulvovaginal candidiasis (VVC) and are frequently associated with reduced susceptibility to commonly used azole antifungals. In sub-Saharan Africa, empirical azole therapy remains widespread despite limited local resistance data. This study aimed to determine the species distribution and antifungal susceptibility patterns of NAC isolates among women presenting with abnormal vaginal discharge in Western Uganda.

Methods

we conducted a hospital-based cross-sectional study among 314 women aged 18–49 years attending Mubende Regional Referral Hospital between May and August 2025. High vaginal swabs were cultured on Sabouraud Dextrose Agar, and Candida species were identified using CHROMagar™ Candida. Antifungal susceptibility testing was performed using the disc diffusion method for fluconazole, clotrimazole, miconazole, and amphotericin B, while caspofungin susceptibility was determined using the E-test. Results were interpreted according to established laboratory standards.

Results

Non-albicans Candida species were isolated in 23.6% (74/314) of participants. Candida glabrata was the predominant species (41.9%), followed by C. tropicalis (29.7%) and C. krusei (18.9%). Overall resistance to fluconazole was high (82.4%), with particularly elevated resistance among C. tropicalis (95.5%) and C. krusei (85.7%). Resistance to clotrimazole was observed in 52.7% of isolates. All NAC isolates demonstrated complete susceptibility to amphotericin B and caspofungin.

Conclusions

Non-albicans Candida species causing VVC in this setting exhibit alarmingly high resistance to azole antifungals, undermining the effectiveness of standard empirical therapy. Routine species identification and antifungal susceptibility testing, alongside strengthened antifungal stewardship, are urgently required to guide appropriate management in resource-limited settings.