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Selection ofCandida glabrata strains with reduced susceptibility to azoles in four liver transplant patients with invasive candidiasis

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Abstract

The cases of four liver transplant recipients who developed invasive candidiasis (2 cholangitis, 1 perihepatic abscess, 1 candidemia) due to azole-resistantCandida glabrata are reported. Three patients were receiving azolic compounds (2 itraconazole, 1 fluconazole) when the infection was diagnosed. All four patients received fluconazole as intestinal decontamination during the first three weeks post transplantation. The infections occurred two months after transplantation in all patients, and in one patientCandida infection was the direct cause of death. Infection of the biliary tree was the origin of candidiasis in three patients; the fourth patient developed neutropenic-related candidemia. Fluconazole MICs exceeded 16 μg/ml in all cases; itraconazole MICs were 16, 2, 1, and 2 μg/ml, respectively. The potential role ofCandida species other thanalbicans in these patients after administration of azole agents is discussed.

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References

  1. Goodman JL, Winston DJ, Greenfield RA, Chandrasekar PH, Fox B, Kaizer H, Shadduck RK, Shea TC, Stiff P, Friedman DJ, Powderly WG, Silber JG, Horowitz H, Lichtin A, Wolff SN, Mangan KF, Silver SM, Weisdorf D, Ho WG, Gilbert G, Buell D: A controlled trial of fluconazole to prevent fungal infections in patients undergoing bone marrow transplantation. New England Journal of Medicine 1992, 326: 845–851.

    PubMed  Google Scholar 

  2. Wingard JR, Merz WG, Rinaldi MG, Johnson TR, Karp JE, Saral R: Increase inCandida krusei infection among patients with bone marrow transplantation and neutropenia treated prophylactically with fluconazole. New England Journal of Medicine 1991, 325: 1274–1277.

    PubMed  Google Scholar 

  3. Winston DJ, Chandrasekar PH, Lazarus HM, Goodman JL, Silber JL, Horowitz H, Shadduck RK, Rosenfeld CS, Ho WG, Islam MZ, Buell DN: Fluconazole prophylaxis of fungal infections in patients with acute leukemia. Results of a randomized placebo-controlled, double-blind, multicenter trial. Annals of Internal Medicine 1993, 118: 495–503.

    PubMed  Google Scholar 

  4. Chandrasekar PH, Gatny CM: The effect of fluconazole prophylaxis on fungal colonization in neutropenic cancer patients. Journal of Antimicrobial Chemotherapy 1994, 33: 309–318.

    PubMed  Google Scholar 

  5. Borg von Zepelin M, Eiffert H, Kann M, Ruchel R: Changes in the spectrum of fungal isolates: results from clinical specimens gathered in 1987/88 compared with those in 1991/92 in the University Hospital Göttingen, Germany. Mycoses 1993, 36: 247–253.

    PubMed  Google Scholar 

  6. Wingard JR, Merz WG, Rinaldi MG, Miller CB, Karp JE, Saral R: Association ofTorulopsis glabrata infections with fluconazole prophylaxis in neutropenic bone marrow transplant patients. Antimicrobial Agents and Chemotherapy 1993, 37: 1847–1849.

    PubMed  Google Scholar 

  7. Persons DA, Laughlin M, Tanner D, Perfect J, Gockerman JP, Hathorn JW: Fluconazole andCandida krusei fungemia. New England Journal of Medicine 1991, 325: 1315.

    Google Scholar 

  8. Mcllroy MA: Failure of fluconazole to suppress fungemia in a patient with fever, neutropenia and typhlitis. Journal of Infectious Diseases 1991, 163: 420–421.

    PubMed  Google Scholar 

  9. Paya CV: Fungal infections in solid-organ transplantation. Clinical Infectious Diseases 1993, 16: 677–688.

    PubMed  Google Scholar 

  10. Meunier F, Aoun M, Gerard M: Therapy for oropharyngeal candidiasis in the immunocompromised host. A randomized double-blind study of fluconazole vs. ketoconazole. Reviews of Infectious Diseases 1990, 12, Supplement 3: 364–368.

    PubMed  Google Scholar 

  11. He X, Tiballi RN, Zarins LT, Bradley SF, Sangeorzan JA, Kauffman CA: Azole resistance in oropharyngealCandida albicans strains isolated from patients infected with human immunodeficiency virus. Antimicrobial Agents and Chemotherapy 1994, 38: 2495–2497.

    PubMed  Google Scholar 

  12. Ruhnke M, Eigler A, Tennagen I, Geiseler B, Engelmann E, Trautmann M: Emergence of fluconazole-resistant strains ofCandida albicans in patients with recurrent oropharyngeal candidosis and human immunodeficiency virus infection. Journal of Clinical Microbiology 1994, 32: 2092–2098.

    PubMed  Google Scholar 

  13. White DJ, Johnson EM, Warnock DWTI: Management of persistent vulvo vaginal candidosis due to azole-resistantCandida glabrata. Genitourinary Medicine 1993, 69: 112–114.

    PubMed  Google Scholar 

  14. National Committee for Clinical Laboratory Standards. Reference method for broth dilution antifungal susceptibility testing for yeasts. Proposed standard M27-P. NCCLS, Villanova, PA, 1992.

    Google Scholar 

  15. Polanco AM, Rodríguez-Tudela JL, Baquero F, Sánchez-Sousa A, Martínez-Suarez J: Improved method of determining the susceptibility ofCandida albicans to fluconazole. Journal of Antimicrobial Chemotherapy 1995, 35: 155–159.

    Google Scholar 

  16. Rodríguez-Tudela JL, Martínez-Suarez JV: Defining conditions for the microbroth antifungal susceptibility tests: influence of RPMI and RPMI-2% glucose on the selection of endpoint criteria. Journal of Antimicrobial Chemotherapy 1995, 35: 739–749.

    PubMed  Google Scholar 

  17. Odds FC, Vranckx L, Woestenborghs F: Antifungal susceptibility testing of yeasts: evaluation of technical variables for test automation. Antimicrobial Agents and Chemotherapy 1995, 39: 2051–2060.

    PubMed  Google Scholar 

  18. Scheven M: Testing susceptibility of fungi to fluconazole. European Journal of Clinical Microbiology & Infectious Diseases 1993, 12: 393–395.

    Google Scholar 

  19. Galgiani JN, Stevens DA: Antimicrobial susceptibility testing of yeasts: a turbidimetric technique independent of inoculum size. Antimicrobial Agents and Chemotherapy 1976, 10: 721–726.

    PubMed  Google Scholar 

  20. Rodríguez-Tudela JL, Berenguer J, Martínez-Suárez V, Sánchez R: Comparison of a spectrophotometric microdilution method with RPMI-2% glucose with the National Committee for Clinical Laboratory Standards reference macrodilution method M27-P for in vivo susceptibility testing of amphotericin B, flucytosine, and fluconazole againstCandida albicans. Antimicrobial Agents and Chemotherapy 1996, 40: 1998–2003.

    PubMed  Google Scholar 

  21. Quereda C, Polanco AM, Giner C, Sánchez-Sousa A, Pereira E, Navas E, Fortún J, Guerrero A, Baquero F: Correlation between in vitro resistance to fluconazole and clinical outcome of oropharyngeal candidiasis in HIV-infected patients. European Journal of Clinical Microbiology & Infectious Diseases 1996, 15: 30–37.

    Google Scholar 

  22. Dermoumi H: In vitro susceptibility of yeast isolates from the blood to fluconazole and amphotericin B. Chemotherapy 1992, 38: 112–117.

    PubMed  Google Scholar 

  23. Martin E, Parras P, Lozano MC: In vitro susceptibility of 245 yeast isolates to amphotericin B, 5-fluorocytosine, ketoconazole, fluconazole and itraconazole. Chemotherapy 1992, 38: 335–339.

    PubMed  Google Scholar 

  24. Morace G, Manzara S, Dettori G: In vitro susceptibility of 119 yeast isolates to fluconazole, 5-fluorocytosine, amphotericin B and ketoconazole. Chemotherapy 1991, 37: 23–31.

    PubMed  Google Scholar 

  25. Vanden Bossche H, Marichal P, Odds FC, Le Jeune L, Coene MC: Characterization of an azole-resistantCandida glabrata isolate. Antimicrobial Agents and Chemotherapy 1992, 36: 2602–2610.

    PubMed  Google Scholar 

  26. Warnock DW, Burke MJ, Cope EM, Johnson EM, Von Fraunhofer NA, Williams EW: Fluconazole resistance inCandida glabrata. Lancet 1988, ii: 1310.

    Google Scholar 

  27. Kerridge D, Nicholas RO: Drug resistance in the opportunistic pathogensCandida albicans andCandida glabrata. Journal of Antimicrobial Chemotherapy 1986, 18, Supplement B: 39–49.

    PubMed  Google Scholar 

  28. Hitchcock CA, Pye GW, Troke PP, Johnson EM, Warnock DW: Fluconazole resistance inCandida glabrata. Antimicrobial Agents and Chemotherapy 1993, 37: 1962–1965.

    PubMed  Google Scholar 

  29. Tollemar J, Holmberg K, Ringden O, Lönnqvist B: Surveillance tests for the diagnosis of invasive fungal infections in bone marrow transplant recipients. Scandinavian Journal of Infectious Diseases 1989, 21: 205–212.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Clinical Microbiology and Infectious Diseases, Ramón y Cajal Hospital, Carretera de Colmenar km 9.1, 28034, Madrid, Spain

    J. Fortún, J. J. Velasco, A. Sánchez-Sousa, C. Quereda & A. Guerrero

  2. Department of Gastroenterology, Ramón y Cajal Hospital, Carretera de Colmenar km 9.1, 28034, Madrid, Spain

    A. López -San Román & R. Bárcena

  3. Department of Surgery, Ramón y Cajal Hospital, Carretera de Colmenar km 9.1, 28034, Madrid, Spain

    E. de Vicente & J. Nuño

  4. Department of Anaesthesiology, Ramón y Cajal Hospital, Carretera de Colmenar km 9.1, 28034, Madrid, Spain

    G. Monge, A. Candela & A. Honrubia

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  1. J. Fortún
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  2. A. López -San Román
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  3. J. J. Velasco
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  4. A. Sánchez-Sousa
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  5. E. de Vicente
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  6. J. Nuño
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  7. C. Quereda
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  8. R. Bárcena
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  9. G. Monge
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  10. A. Candela
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Fortún, J., Román, A.L.S., Velasco, J.J. et al. Selection ofCandida glabrata strains with reduced susceptibility to azoles in four liver transplant patients with invasive candidiasis. Eur. J. Clin. Microbiol. Infect. Dis. 16, 314–318 (1997). https://doi.org/10.1007/BF01695638

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