Disseminated candidiasis due to amphotericin B-resistant Candida albicans.
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.
Conly
J
J
Department of Medicine, Royal University Hospital, University of Saskatchewan, Saskatoon, Canada.
Rennie
R
R
Johnson
J
J
Farah
S
S
Hellman
L
L
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*
D000666:Amphotericin B; D005437:Flucytosine