Prevalence, drug resistance and genetic diversity of <i>Candida glabrata</i> in the reproductive tract of pregnant women in Hainan and comparison with global multilocus sequence data

This study investigates the prevalence, drug resistance, and genetic diversity of <i>Candida glabrata</i>, a significant non-albicans <i>Candida</i> species, among pregnant women in Hainan, China. We collected 3,806 reproductive tract secretion samples from women with vaginal discomfort and isolated 594 <i>Candida</i> strains, including <i>C. albicans</i> (45.1%), <i>C. glabrata</i> (36.2%), <i>C. dubliniensis</i> (12.2%), <i>C. parapsilosis</i> (2.7%), <i>C. tropicalis</i> (2.7%), and <i>C. krusei</i> (1.2%). Antifungal susceptibility testing showed that 64.5% of the isolates were intermediate or resistant to at least one of four antifungal agents: fluconazole, itraconazole, voriconazole, and amphotericin B. Among 215 <i>C. glabrata</i> isolates, 81.4% were intermediate or resistant to at least one antifungal, with 10% showing resistance to multiple agents. Multilocus sequence typing (MLST) of 52 <i>C. glabrata</i> strains from the reproductive tract, 53 from oral cavities, and 17 from environmental sources revealed 14 sequence types (STs), with six STs shared among these niches, indicating a highly clonal population structure. Comparisons with the global MLST database showed both shared and distinct characteristics among <i>C. glabrata</i> populations in Hainan and other regions, highlighting significant differentiation. We discuss the implications of these findings to the epidemiology and evolution of this pathogen.