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Determinants for the Development of Oropharyngeal Colonization or Infection by Fluconazole-Resistant Candida Strains in HIV-Infected Patients

  • M. Masiá Canuto
  • F. Gutiérrez Rodero
  • V. Ortiz de la Tabla Ducasse
  • I. Hernández Aguado
  • C. Martín González
  • A. Sánchez Sevillano
  • A. Martín Hidalgo
Article

Abstract

 A point prevalence study to document oral yeast carriage was undertaken. Risk factors for the development of oropharyngeal colonization or infection by fluconazole-resistant Candida strains in HIV-infected patients were investigated with a case-control design. Cases included all patients with fluconazole-resistant strains (MIC≥64 μg/ml), and controls were those with susceptible (MIC≤8 μg/ml) or susceptible-dependent-upon-dose (MIC 16–32 μg/ml) strains. One hundred sixty-eight Candida strains were isolated from 153 (88%) patients, 28 (16%) of whom had oropharyngeal candidiasis. Overall, 19 (12%) of the patients harbored at least one resistant organism (MIC≥64 μg/ml). Among patients with resistant strains, tuberculosis (P<0.001), esophageal candidiasis (P=0.001), clinical thrush (P<0.001), and a CD4+ cell count <200/mm3 (P=0.03) were more frequent. These patients had also been treated more commonly with antituberculous drugs (adjusted odds ratio [OR] 6.13; 95% confidence interval [CI] 2.11–17.80), ciprofloxacin (OR 6.0; 95% CI 1.23–29.26), fluconazole (OR 4.59; 95% CI 1.55–13.52), and steroids (OR 4.13; 95% CI 1.11–15.39). Multivariate analysis showed that the determinants for fluconazole resistance were therapy with antituberculous drugs (OR 3.61; 95% CI 1.08–12.07;P=0.03) and one of the following: previous tuberculosis (OR 3.53; 95% CI 1.08–14.57;P=0.03) or fluconazole exposure (OR 3.41; 95% CI 1.10–10.54). Findings from this study indicate that treatment with antituberculous drugs, previous tuberculosis, and fluconazole exposure are the strongest determinants for development of oropharyngeal colonization or infection by fluconazole-resistant Candida strains in HIV-infected patients.

Keywords

Fluconazole Candidiasis Resistant Organism Candida Strain Oropharyngeal Candidiasis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2000

Authors and Affiliations

  • M. Masiá Canuto
    • 1
  • F. Gutiérrez Rodero
    • 1
  • V. Ortiz de la Tabla Ducasse
    • 2
  • I. Hernández Aguado
    • 3
  • C. Martín González
    • 2
  • A. Sánchez Sevillano
    • 1
  • A. Martín Hidalgo
    • 1
  1. 1.Servicio de Medicina Interna, Unidad de Enfermedades Infecciosas, Hospital General Universitario de Elche, Partida de Huertos y Molinos s/n, 03202 Elche, Alicante, Spain e-mail: fgutierrezr@medynet.comES
  2. 2.Sección de Microbiología, Hospital Universitario de San Juan, Alicante, SpainES
  3. 3.Universidad Miguel Hernández, Elche, Alicante, SpainES

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