ArticleInfection2026
High azole resistance among non-albicans Candida species causing vulvovaginal candidiasis in Western Uganda: a cross-sectional study.
Article in Infection, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundNon-albicans Candida (NAC) species are increasingly implicated in vulvovaginal candidiasis (VVC) and are frequently associated with reduced susceptibility to commonly used azole antifungals. In sub-Saharan Africa, empirical azole therapy remains widespread despite limited local resistance data. This study aimed to determine the species distribution and antifungal susceptibility patterns of NAC isolates among women presenting with abnormal vaginal discharge in Western Uganda.
methodswe conducted a hospital-based cross-sectional study among 314 women aged 18-49 years attending Mubende Regional Referral Hospital between May and August 2025. High vaginal swabs were cultured on Sabouraud Dextrose Agar, and Candida species were identified using CHROMagar™ Candida. Antifungal susceptibility testing was performed using the disc diffusion method for fluconazole, clotrimazole, miconazole, and amphotericin B, while caspofungin susceptibility was determined using the E-test. Results were interpreted according to established laboratory standards.
resultsNon-albicans Candida species were isolated in 23.6% (74/314) of participants. Candida glabrata was the predominant species (41.9%), followed by C. tropicalis (29.7%) and C. krusei (18.9%). Overall resistance to fluconazole was high (82.4%), with particularly elevated resistance among C. tropicalis (95.5%) and C. krusei (85.7%). Resistance to clotrimazole was observed in 52.7% of isolates. All NAC isolates demonstrated complete susceptibility to amphotericin B and caspofungin.
conclusionsNon-albicans Candida species causing VVC in this setting exhibit alarmingly high resistance to azole antifungals, undermining the effectiveness of standard empirical therapy. Routine species identification and antifungal susceptibility testing, alongside strengthened antifungal stewardship, are urgently required to guide appropriate management in resource-limited settings.
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