Epidemiology and Antifungal Resistance Rates in Vulvovaginal Candidosis: Results From a 5-Year Greek Survey, 2020 to 2024

Candida species, particularly Candida albicans constitute a major cause of vulvovaginal candidiasis (VVC) in women of reproductive age. Over the years, the epidemiologic patterns of VVC have been shifting towards non-albicans (NAC) species and the antifungal resistance rates have been gradually increasing. We performed a retrospective study to determine the epidemiological pattern of VVC and the antifungal susceptibility rates in Greece between 2020 and 2024 in a Maternity / Gynaecological Clinic. Species identification and ssusceptibility testing was performed using Vitek 2 and assessed according to EUCAST. In total, 526 vaginal swab samples were collected, including C.albicans (57.9%) and NAC sp (42.1%). Median women age was 36.3(10-92), and was comparable between groups. Among NAC, C. glabrata (26.4%), was identified as the predominant species, followed by C. krusei (7.6%), C. parapsilosis (5.1%) and C. tropicalis (3.0%). For C. albicans isolates, fluconazole and itraconazole resistance rates increased from 9,3% in 2020 to 22.3% and 20.9% in 2024 respectively. No resistance to voriconazole was detected until 2023 and 2024, that rates reached 3.2 and 15.2 respectively. For NAC, except for C. glabrata and C. krusei that exhibit intrinsic resistance to fluconazole, C parapsilosis and C. tropicalis showed decreased susceptibility to fluconazole at 3.5 and 12.5% respectively. Echinocandin resistance rates remained low throughout the study period with an exception for C. glabrata which exhibited a resistance rate of 13,8% to caspofungin. In a number of cases, insufficient evidence pertaining to clinical breakpoints for fungi did not allow in vitro susceptibility assessment. The escalation of antifungal resistance and the shifting epidemiologic patterns of VVC constitutes a significant concern and highlights the need for nationwide surveillance programs, more focused diagnostic methods, proper antifungal stewardship policies as well as the development of novel antifungal treatments.