title: Detection and significance of fluconazole resistance in oropharyngeal candidiasis in human immunodeficiency virus-infected patients.
abstract: The epidemiology and clinical significance of fluconazole resistance were assessed in a cohort of advanced human immunodeficiency virus (HIV)-infected patients with recurrent oropharyngeal candidiasis. Fifty patients were prospectively evaluated using a novel method of detecting fluconazole resistance with chromogenic media containing fluconazole; results were confirmed with macrobroth testing. Resistant yeasts, defined as MICs > or = 8 micrograms/mL, were detected in 16 (32%) of 50 patients: 7 (14%) had resistant Candida albicans, 7 (14%) had resistant non-C. albicans yeast, and 2 (4%) had mixed resistant yeasts. MICs were > or = 32 in 11 of 16 isolates. Previous fluconazole use and severe immunosuppression were risk factors for resistance. However, 5 of 26 patients had resistant isolates with no prior fluconazole use, and all were severely immunosuppressed. Despite the high prevalence of resistance, 48 patients clinically responded to fluconazole. Fluconazole-resistant C. albicans and non-C. albicans yeast infections are common in patients with advanced immunodeficiency, but clinical efficacy of fluconazole remains high.
authors.affiliation: Department of Medicine, University of Texas Health Science Center at San Antonio 78284-7881, USA.
authors.forename: S G
authors.initials: SG
authors.lastname: Revankar
authors.forename: W R
authors.initials: WR
authors.lastname: Kirkpatrick
authors.forename: R K
authors.initials: RK
authors.lastname: McAtee
authors.forename: O P
authors.initials: OP
authors.lastname: Dib
authors.forename: A W
authors.initials: AW
authors.lastname: Fothergill
authors.forename: S W
authors.initials: SW
authors.lastname: Redding
authors.forename: M G
authors.initials: MG
authors.lastname: Rinaldi
authors.forename: T F
authors.initials: TF
authors.lastname: Patterson
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy*; D000935:Antifungal Agents / Q000627:therapeutic use*; D002176:Candida albicans / Q000187:drug effects; D002180:Candidiasis, Oral / Q000188:drug therapy*; D004351:Drug Resistance; D015725:Fluconazole / Q000627:therapeutic use*; D006801:Humans; D008826:Microbial Sensitivity Tests
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole