title: Disseminated candidiasis due to amphotericin B-resistant Candida albicans.
abstract: Although development of resistance in Candida albicans to amphotericin B is considered rare, C. albicans was persistently recovered from a 28-year-old man after a prolonged course of broad-spectrum antimicrobial therapy for a pancreatic abscess. Determination of the MICs of drugs for C. albicans in Sabouraud broth revealed MICs of 2.5 mg/l amphotericin B, greater than 40 mg/l ketoconazole, 2.5 mg/l miconazole, and greater than 40 mg/l 5-fluorocytosine. Synergy testing revealed a MIC of 0.3 mg/l amphotericin B in the presence of 2.5 mg/l 5-fluorocytosine. When intravenous 5-fluorocytosine was added to the patient's antifungal regimen, achieving levels of 125 mg/l, negative blood cultures resulted for the first time. This suggests there may be a clinical use for in vitro synergy testing as an adjunct to guide antifungal therapy for fungemia due to amphotericin B-resistant C. albicans.
authors.affiliation: Department of Medicine, Royal University Hospital, University of Saskatchewan, Saskatoon, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Conly
authors.forename: R
authors.initials: R
authors.lastname: Rennie
authors.forename: J
authors.initials: J
authors.lastname: Johnson
authors.forename: S
authors.initials: S
authors.lastname: Farah
authors.forename: L
authors.initials: L
authors.lastname: Hellman
mesh_terms: D000038:Abscess / Q000188:drug therapy*; D000328:Adult; D000666:Amphotericin B / Q000494:pharmacology* / Q000627:therapeutic use; D002176:Candida albicans / Q000187:drug effects*; D002177:Candidiasis / Q000188:drug therapy*; D004352:Drug Resistance, Microbial; D005437:Flucytosine / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D010182:Pancreatic Diseases / Q000188:drug therapy*
chemical_list: D000666:Amphotericin B; D005437:Flucytosine