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<p>Vulvovaginal candidiasis (VVC) affects millions of women worldwide. The rates of antifungal resistance are increasing, which can complicate therapy. Whether circulating inflammatory biomarkers reflect antifungal susceptibility patterns in localized VVC remains unclear. In this study, 163 adult women with culture‑confirmed VVC were recruited from the University of Tabuk hospitals in Tabuk, Saudi Arabia. Demographic and clinical data were extracted from electronic records. Plasma concentrations of inflammatory markers were quantified by ELISA. Antifungal susceptibility was determined according to CLSI guidelines. Group comparisons used the Mann–Whitney U test, associations were determined by Spearman’s correlation, and logistic regression identified independent predictors of antifungal susceptibility. No significant differences in circulating inflammatory markers were observed between resistant and susceptible isolates for any agent after Bonferroni adjustment, except ketoconazole, for which resistance showed an association with lower TGF-β (<i>p</i> = 0.008). However, this association did not remain significant in adjusted models. Spearman analysis showed weak correlations between biomarkers and antifungal MIC<sup>90</sup>, MIC<sup>50</sup>, and MFC values. Logistic regression identified no biomarker as an independent predictor of susceptibility for any drug (all <i>p</i> &gt; 0.05). These findings indicate that systemic inflammatory markers may have limited clinical value as antifungal resistance predictors in localized mucosal infections like VVC. Rather than a purely negative finding, this result carries clinical significance: it establishes that circulating biomarkers cannot substitute for direct antifungal susceptibility testing in localized VVC, underscoring the continued necessity of microbiological testing over systemic biomarker-based prediction. Since systemic biomarkers did not predict antifungal resistance in localized VVC, these findings support the continued use of direct antifungal susceptibility testing for guiding treatment decisions.</p>

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Circulating inflammatory biomarkers and antifungal susceptibility in Candida albicans vulvovaginal candidiasis: a retrospective observational cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月1日

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  • Mohammad Zubair,
  • Yazeed Albalawi

摘要

Vulvovaginal candidiasis (VVC) affects millions of women worldwide. The rates of antifungal resistance are increasing, which can complicate therapy. Whether circulating inflammatory biomarkers reflect antifungal susceptibility patterns in localized VVC remains unclear. In this study, 163 adult women with culture‑confirmed VVC were recruited from the University of Tabuk hospitals in Tabuk, Saudi Arabia. Demographic and clinical data were extracted from electronic records. Plasma concentrations of inflammatory markers were quantified by ELISA. Antifungal susceptibility was determined according to CLSI guidelines. Group comparisons used the Mann–Whitney U test, associations were determined by Spearman’s correlation, and logistic regression identified independent predictors of antifungal susceptibility. No significant differences in circulating inflammatory markers were observed between resistant and susceptible isolates for any agent after Bonferroni adjustment, except ketoconazole, for which resistance showed an association with lower TGF-β (p = 0.008). However, this association did not remain significant in adjusted models. Spearman analysis showed weak correlations between biomarkers and antifungal MIC90, MIC50, and MFC values. Logistic regression identified no biomarker as an independent predictor of susceptibility for any drug (all p > 0.05). These findings indicate that systemic inflammatory markers may have limited clinical value as antifungal resistance predictors in localized mucosal infections like VVC. Rather than a purely negative finding, this result carries clinical significance: it establishes that circulating biomarkers cannot substitute for direct antifungal susceptibility testing in localized VVC, underscoring the continued necessity of microbiological testing over systemic biomarker-based prediction. Since systemic biomarkers did not predict antifungal resistance in localized VVC, these findings support the continued use of direct antifungal susceptibility testing for guiding treatment decisions.