| Abstract: |
SummaryThe present study was conducted at Obstetrics and Gynecology and Microbiology Departments, Faculty of Medicine, Zagazig University.The study included 90 female patients in childbearing period who divided into 2 groups:Group A: 60 patients (cases), they are IUCD users clinically diagnosed to have Candida vaginitis.Group B: 30 patients (control), they are IUCD users with no symptoms or signs of Candida vaginitis.For each case, a full history, general and local examination were done.Vaginal swab and IUD sampling for each case were done under complete aseptic conditions and transported to the laboratory within one hour where different studies were carried out.Identification of C. albicans was done using germ tube test, chlamydospore formation and sucrose assimilation.Formation of biofilm in vitro and antifungal susceptibility for both biofilm and planktonic Candida to fluconazole and amphotericin B.In the present study, the ages of group A (cases) ranged from 20 to 45 years with mean ± SD of 29.085 ± 6.4, while ages of group B (control) ranged from 20 to 44 years with mean ± SD of 29.6 ± 6.25.The most common parity of groups A and B ranged from 3-5 representing 48.3% and 53.3% respectively.Duration of use of IUCDs ranged from 1-3 years between groups A and B representing 53.3% and 50% respectively.IUCDs removed were of type copper T380 or Nova T and commonly removed due to resistant and recurrent pelvic infection.There is a total 49 from 113 C. albicans isolates obtained from vaginal swabs and IUCDs were biofilm positive.The results for biofilm quantitation using XTT reduction assay represented that the mean for 40 isolates was 0.485 (± 0.109 SD) with a range of 0.32-0.691.Biofilm susceptibility testing revealed that:For fluconazole, the readings of the XTT reduction assay in biofilms at concentrations as high as 1024 ?g/ml were similar to those of the control biofilms (no drug).About amphotericin B, we found that MIC50 value for C. albicans biofilm determined in our study of 50% XTT reduction of that of biofilm control lies within the sensitive range, while at 80% XTT reduction of that of biofilm control lies within the resistant range. However, amphotericin B MIC90 value for C. albicans biofilm determined at 50% and 80% XTT reduction of that of biofilm control lies within the resistant range.Out of identified C. albicans isolates (the planktonic forms of biofilm forming strains), 40 isolates were picked up and subjected to susceptibility testing to fluconazole and amphotericin B using broth microdilution, spectrophotometric broth microdilution, and XTT reduction assay.We could found that there are no resistance isolates for amphotericin B where the percentage of resistant isolates to fluconazole was 12.5% of C. albicans isolates.So, decreased susceptibility of sessile cells to antimicrobial agents compared to that of planktonic cells has been reported extensively.ConclusionBiofilms of C. albicans on medical devices influence treatment decisions, particularly in patients who do not respond to initial appropriate therapy. So, in our study, It could be concluded that Candida biofilm in IUCD users significantly resistant to routine antifungal agents such as fluconazole and mostly resistant to amphotericin B. So, removal of IUCD and usage of novel classes of antifungal agents (lipid formulation of amphotericin and echinocandins) provide valuable measures for treatment of resistant Candida vaginitis.References
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