ﻣﻘﺎﯾﺴﻪ ﺣﺴﺎﺳﯿﺖ ﺑﻪ داروي ﺿﺪ ﻗﺎرﭼﯽ ﻓﻠﻮﮐﻮﻧﺎزول ﺑﺎ اﯾﺘﺮاﮐﻮﻧﺎزول در ﻣﺒﺘﻼﯾﺎن ﺑﻪ ﮐﺎﻧﺪﯾﺪﯾﺎزﯾﺲ واژﯾﻨﺎل ﻣﺮاﺟﻌﻪ ﮐﻨﻨﺪه ﺑﻪ ﺑﯿﻤﺎرﺳﺘﺎنﻫﺎي ﺗﺎﺑﻌﻪ داﻧﺸﮕﺎه آزاد اﺳﻼﻣﯽ ﻋﻠﻮم ﭘﺰﺷﮑﯽ ﺗﻬﺮان

Comparison of sensitivity to fluconazole and itraconazole in patients with vaginal candidiasis referred to hospitals of Islamic Azad University, Tehran Medical Sciences

كانديديازيس واژينال، عامل شايع عفونت در خانم­ها است. فلوكونازول بيشتراز بقيه داروها جهت درمان تجويز مي­شود. بنابراين تعيين ميزان مقاومت دارويي كانديدا به فلوكونازول و مقايسه آن با داروي ايتراكونازول به عنوان جانشين از اهداف اصلي اين بررسي بود. روش بررسي: در اين مطالعه مقطعي تجربي، از 180 بيمار با علائم كانديديازيس واژينال ضمن معاينه باليني، نمونه برداري و كشت انجام گرديد. گونه كانديدا آلبيكنس به كمك روش هاي مرفولوژيك و فيزيولوژيك و كانديداهاي غير كانديدا آلبيكنس به كمك روش PCR-RFLP تعيين گونه شدند. تست حساسيت به داروهاي ضد قارچي براساس پروتوكل CLSI M44-A به روش ديسك ديفيوژن انجام شد.  ﯾﺎﻓﺘﻪﻫﺎ: از 180 ﺑﯿﻤﺎر ﻣﻮرد ﺑﺮرﺳﯽ، 93 ﺑﯿﻤﺎر داراي ﮐﺸﺖ ﻣﺜﺒﺖ و 98 اﯾﺰوﻟﻪ ﮐﺎﻧﺪﯾﺪا ﺟﺪا ﺷﺪ. ﻣﯿﺎﻧﮕﯿﻦ ﺳﻨﯽ ﺑﯿﻤﺎران 0/73± 30 ﺳﺎل و ﺷﺎﯾﻊﺗﺮﯾﻦ ﻋﻼﻣﺖﻫﺎي ﺑﺎﻟﯿﻨﯽ، ﺧﺎرش )98%>( ، ﺗﺮﺷﺤﺎت واژن )88%( ﮔﺰارش ﺷﺪ. ﮐﺎﻧﺪﯾﺪا آﻟﺒﯿﮑﻨﺲ )80/61%( ﺷﺎﯾﻊﺗﺮﯾﻦ ﮔﻮﻧﻪ ﻋﺎﻣﻞ ﺑﯿﻤﺎري ﺗﺸﺨﯿﺺ داده ﺷﺪ. ﻣﯿﺰان ﻣﻘﺎوﻣﺖ ﮐﺎﻧﺪﯾﺪا آﻟﺒﯿﮑﻨﺲ ﺑﻪ ﻓﻠﻮﮐﻮﻧﺎزول و اﯾﺘﺮاﮐﻮﻧﺎزول ﺑﻪ ﺗﺮﺗﯿﺐ 45/6% و 16/5% و ﺑﺮاي ﮐﺎﻧﺪﯾﺪاﻫﺎي ﻏﯿﺮ آﻟﺒﯿﮑﻨﺲ ﻪ ﺗﺮﺗﯿﺐ 53% و 42% ﻣﺸﺎﻫﺪه ﺷﺪ. اﯾﻦ ﺗﻔﺎوت از ﻧﻈﺮ آﻣﺎري ﻣﻌﻨﯽ دار ﻧﺸﺎن داده ﺷﺪ )0/0001

Vaginal candidiasis is a common cause of vaginal infections. Currently, for treatment of these infections, fluconazole is prescribed more than other drugs; so determining the drug resistance of Candida to fluconazole and comparing it with itraconazole as a substitute has been one of the main objectives of this study. Materials and methods: Of 180 patients with symptoms of vaginal candidiasis, clinical examination, sampling and culture were performed. Candida albicans were identified by morphological and physiological methods and non-Candida albicans candida isolates by PCR-RFLP method. Susceptibility testing for antifungal drugs was performed by disk diffusion method based on CLSI M44-A protocol. Results: Out of 180 patients, 93 patients with positive culture and 98 strain of Candida were isolated. The mean age of patients was 30±0.73 years and the most common clinical complaints was itching (>98%) and vaginal discharge (88%). Candida albicans (80.61%) was the most common causative agent. The resistance of Candida albicans to fluconazole and itraconazole was 45.6% and 16.5%, respectively, and for nonalbicans candida isolates were 53% and 42%, respectively. This difference was statistically significant (P<0.0001). Conclusion: The results of this study suggest that culturing of vaginal samples have essential role for diagnosis of vaginal candidiasis, and treatment with antifungal drugs should be performed after antifungal susceptibility tests.