Vulvovaginal Candidiasis in Pregnancy: Species Distribution and Antifungal Resistance Patterns to Commonly Used Topical Azoles at a Tertiary Care Center in Central India

Introduction: Vulvovaginal candidiasis (VVC) is a common fungal infection during pregnancy. Topical azoles, including clotrimazole and miconazole, are recommended as first-line therapy; however, data on the distribution of Candida species and their in vitro susceptibility to these agents remain limited. This study aimed to determine the species distribution of Candida causing VVC in pregnant women and evaluate the in vitro activity of clotrimazole and miconazole. Materials and methods: This six-month observational cross-sectional study was conducted at a tertiary care center in Central India. High vaginal swabs were collected from 108 symptomatic pregnant women and examined by direct microscopy and culture. Candida isolates were identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Antifungal susceptibility testing for clotrimazole and miconazole was performed using the Etest method. Minimum inhibitory concentration (MIC) values were analyzed descriptively because clinical breakpoints (CBPs) and epidemiological cutoff values (ECVs) for these topical azoles were unavailable. Descriptive statistics included frequencies, percentages, mean, median, mode, and MIC ranges. Results: Candida species were isolated from 45 of 108 pregnant women (41.67%). Candida albicans was the predominant isolate (36/45, 80.0%), followed by Nakaseomyces glabrata (4/45, 8.89%), Candida tropicalis (2/45, 4.44%), Pichia kudriavzevii (1/45, 2.22%), Candida parapsilosis (1/45, 2.22%), and Candida lusitaniae (1/45, 2.22%). Clotrimazole demonstrated lower MIC values than miconazole. Higher MIC values (>32 µg/mL), indicating reduced in vitro activity, were observed in nine (25.0%) Candida albicans isolates with miconazole, compared with one (2.78%) with clotrimazole. Conclusions: Candida albicans remained the predominant cause of VVC among pregnant women. Clotrimazole demonstrated lower MIC values than miconazole in this study, indicating greater in vitro activity based on the observed MIC distribution. Continued surveillance of antifungal susceptibility patterns and the establishment of validated CBPs for topical azoles against Candida species are essential for improving understanding of emerging antifungal resistance and supporting evidence-based management of VVC.