| Chapter I.The characteristics of clinical epidemiology of vulvovaginal candidiasis and identification of pathogenic yeasts.Objectives To investigate species distribution and clinical epidemiology of vulvovaginal candidiasis collected from different regions across China.Methods There were 12 hospitals participated in this study.The vaginal secretions from patients with VVC were collected from September 2017 to March 2018.The germ tube test and chlamydospore formation test were performed to identify the C.albicans.C.glabrata,C.krusei and C.tropicalis could be identified by CHROMagar medium.If there were strains not identified by those methods,DNA sequencing would be taken.Meanwhile,the questionnaires of related data from patients with VVC were collected and analyzed.Results A total of 602 cases were enrolled in this study,including 295(49%)uncomplicated VVC and 307(51%)complicated VVC.Among uncomplicated VVC,30%were RVVC,41%were SWC,23%were VVC with pregnancy,21%were VVC caused by non-albicans Candida,and 1%were VVC with uncontrolled diabetes.14%of the complicated VVC were coupled with more than one factors mentioned above.The subjects were between 16 and 64 years old(average age,32.71 years old),and most of them(60%)were between 25 and 35 years old.There were 602 strains isolated from those VVC patients,539(89.5%)were C.albicans,48(8%)were C.glabrata,7(1.1%)were C.krusei,4(0.7%)were C.parapsilosis,and 4(0.7%)were other Candida spp.The proportion of non-albicans Candida infection among menopause group(>45 years old)was significantly different from that of young group(?30 years old)and middle-aged group(31 to 45 years old)(P<0.05).The suspicious risk factors of complicated VVC were pregnancy,diabetes and Candida species difference.The predisposing factor of RVVC was the regional differences between North and South China.Conclusions This study was the first multicentre study of the clinical epidemiology and related pathogens of VVC with large samples in the mainland of China,including the South and the North.VVC was more frequent in women of childbearing age.The propotion of uncomplicated VVC was similar to that of complicated VVC.Among complicated VVC,RVVC accounted for about 1/3.C.albicans(89.5%)was still the predominant species of VVC in China,while C.glabrata(76%)was the main species in non-albicans Candida.The data also showed significant increases in the prevalence of non-albicans Candida with increases in age.Chapter ?.Antifungal susceptibility testing of Candida isolates causing VVC.Objectives To determine in vitro antifungal susceptibility of Candida isolates causing VVC,so as to provide references for the rational use of drugs for clinical therapy.Methods Antifungal susceptibility testing was performed according to CLSI documents M27-E4,using 11 drugs including fluconazole,itraconazole,voriconazole,posaconazole,miconazole,econazole,clotrimazole,nystatin,amphotericin B,caspofungin,and terbinafine.Results C.albicans isolates were most susceptible(98.5%)to caspofungin,followed by fluconazole(89%)and voriconazole(82%).C.albicans isolates were most resistant(8%)to fluconazole,and least resistant(0.6%)to caspofungin.The proportion of wild type(WT)C.albicans strains in amphotericin B was highest(98.3%),while voriconazole was lowest(55%).The cross resistant rate of C.albicans isolates among fluconazole,itraconazole and voriconazole was 3.5%(20/539),of which 60%(12/20)were from complicated VVC and 30%(6/20)were from RVVC.C.glabrata isolates were most susceptible to caspofungin(90%),and were all dose-dependent susceptible to fluconazole.All of C.glabrata isolates were WT to both amphotericin B and posaconazole,while 15%were non-wild type(NWT)to both itraconazole and voriconazole.Posaconazole and clotrimazole showed the lowest MIC90(0.06ug/ml)against C.albicans.The MIC90 of terbinafine among C.albicans,C.glabrata and C.krusei were all>64ug/ml.As for complicated VVC,the MICs of fluconazole were higher than that of uncomplicated VVC(P<0.05).The proportion of NWT strains among fluconazole in RVVC was also much higher than that in other types of VVC(37%vs.23%,P<0.05).In complicated VVC and RVVC,the proportions of WT strains to itraconazole were all over 80%,which were much higher than that to fluconazole(P<0.01).The MICs of fluconazole,clotrimazole,nystatin and caspofungin among non-albicans Candida were higher than that of C.albicans(P<0.05).Conclusions Most C.albicans strains isolated from VVC in different regions of China were susceptible to the commonly used azoles,including fluconazole and itraconazole,which could be used as empirical treatment.But fluconazole was not the first choice for the treatment of complicated VVC,especially RVVC.Most strains were susceptible to caspofungin and amphotericin B.Terbinafine had a poor effect on Candida spp.in vitro,which was not recommended for the treatment of VVC. |
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