Differential Antifungal Response in Non-albicans Candida Isolates from Vaginal Exudates

Vulvovaginal candidiasis (VVC) is a highly prevalent fungal infection primarily caused by Candida albicans, although the incidence of non-albicans Candida species has recently increased. This study aimed to characterize the antifungal susceptibility profiles of clinical non-albicans Candida isolates donated by laboratories that had previously recovered them from vaginal exudates of patients with VVC. CHROMagar™ Candida, multiplex PCR, and VITEK® MS IVD 3.0 were used to ensure accurate species-level identification of 86 isolates. Of these, 72 were identified as C. albicans and 13 as Candida glabrata. One isolate underwent additional investigation using VITEK 2 YST, VITEK® MS RUO 4.10, and D1/D2 sequencing and was identified as Candida bracarensis. Antifungal susceptibility testing was performed using VITEK® 2, and resistant isolates were confirmed by broth microdilution according to the CLSI M27 reference method. The minimum inhibitory concentrations (MICs) of C. bracarensis were like those of C. glabrata, which exhibits reduced susceptibility to azole antifungals that could lead to therapeutic failure and recurrent VVC. These findings support the use of complementary identification methods to improve the identification of uncommon isolates. Furthermore, MIC determination provides valuable surveillance information for non-albicans Candida, which may contribute to timely and appropriate treatment and help improve health and quality of life.