title: Clinical characteristics of Turkish women with Candida krusei vaginitis and antifungal susceptibility of the C. krusei isolates.
abstract: OBJECTIVE
  Candida krusei causes approximately 1% of vulvovaginal candidiasis (VVC) cases and is naturally resistant to fluconazole. Antifungal testing may be required if C. krusei vaginitis fails to respond to non-fluconazole therapy, particularly in patients with recurrent infections.
  
  
  METHODS
  We investigated the clinical characteristics and antifungal susceptibility profile of vaginal C. krusei isolates. Between 2009 and 2012, we identified 560 unrelated Candida spp.-positive vaginal cultures, of which 28 (5.0%) were C. krusei. These isolates were analyzed according to host factors and the clinical forms of VVC, and their in vitro susceptibility to 10 antifungal agents was tested using a reference microdilution method.
  
  
  RESULTS
  We observed that perineal laceration and increased age (>50 years) were significant predictors of C. krusei in vaginal samples (P < 0.05). All isolates were susceptible to amphotericin B, caspofungin, ketoconazole, and miconazole. Additionally, susceptible dose-dependent and resistant rates were found for fluconazole as 42.9% and 57.1%, respectively. Remarkably, only 42.9% and 67.9% of the isolates were susceptible to itraconazole and voriconazole, respectively.
  
  
  CONCLUSIONS
  Understanding local susceptibility patterns, especially those of non-C. albicans Candida species, can significantly aid in the selection of an effective antifungal agent. The in vivo response of C. krusei vaginitis to various antifungal therapeutics remains unknown and requires further research.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, University of Çukurova, 01330 Adana, Turkey.
authors.forename: Ahmet Bariş
authors.initials: AB
authors.lastname: Güzel
authors.affiliation: Department of Microbiology, Faculty of Medicine, University of Gazi, 06500 Ankara, Turkey ; Department of Microbiology, Faculty of Medicine, University of Erzincan, 24000 Erzincan, Turkey.
authors.forename: Merve
authors.initials: M
authors.lastname: Aydın
authors.affiliation: Division of Mycology, Department of Microbiology, Faculty of Medicine, University of Çukurova, 01330 Adana, Turkey.
authors.forename: Melda
authors.initials: M
authors.lastname: Meral
authors.affiliation: Department of Microbiology, Faculty of Medicine, University of Gazi, 06500 Ankara, Turkey.
authors.forename: Ayşe
authors.initials: A
authors.lastname: Kalkancı
authors.affiliation: Division of Mycology, Department of Microbiology, Faculty of Medicine, University of Çukurova, 01330 Adana, Turkey.
authors.forename: Macit
authors.initials: M
authors.lastname: Ilkit
mesh_terms: D000328:Adult; D000367:Age Factors; D000935:Antifungal Agents / Q000494:pharmacology*; D002175:Candida / Q000187:drug effects* / Q000302:isolation & purification; D002181:Candidiasis, Vulvovaginal / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D004305:Dose-Response Relationship, Drug; D025141:Drug Resistance, Fungal; D005260:Female; D006801:Humans; D016015:Logistic Models; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D014421:Turkey / Q000453:epidemiology
chemical_list: D000935:Antifungal Agents