title: Infection due to fluconazole-resistant Candida in patients with AIDS: prevalence and microbiology.
abstract: A cross-sectional study was conducted to assess the prevalence and microbiology of oral infection due to fluconazole-resistant Candida in patients with AIDS. Oral swab specimens for fungal cultures were obtained from 100 consecutive outpatients with CD4 lymphocyte counts of < 200/mm3. At least one fungal organism demonstrating in vitro resistance to fluconazole (minimum inhibitory concentration, > or = 8 micrograms/mL) was isolated from 26 (41%) of 64 patients for whom cultures were positive. When fluconazole-resistant C. albicans was isolated, in vitro resistance correlated with clinical thrush. None of 10 patients from whom only non-albicans species of Candida were isolated had active thrush. The patients from whom fluconazole-resistant Candida albicans was isolated had lower CD4 cell counts (median, 9/mm3), a greater number of treated episodes of thrush (median, 4.5), and a greater median duration of prior fluconazole treatment (231 days) than did patients from whom fluconazole-susceptible C. albicans was isolated (median CD4 cell count, 58/mm3 [P = .004]; median number of treated episodes of thrush, 2.0 [P = .001]; and median duration of prior fluconazole treatment, 10 days [P = .01]; respectively). In a multivariate analysis, the number of episodes and duration of fluconazole therapy were independent predictors of resistance.
authors.affiliation: Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Maenza
authors.forename: W G
authors.initials: WG
authors.lastname: Merz
authors.forename: M J
authors.initials: MJ
authors.lastname: Romagnoli
authors.forename: J C
authors.initials: JC
authors.lastname: Keruly
authors.forename: R D
authors.initials: RD
authors.lastname: Moore
authors.forename: J E
authors.initials: JE
authors.lastname: Gallant
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology* / Q000382:microbiology*; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D002175:Candida / Q000187:drug effects / Q000302:isolation & purification; D002180:Candidiasis, Oral / Q000188:drug therapy* / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D004352:Drug Resistance, Microbial; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D015999:Multivariate Analysis; D015995:Prevalence; D012008:Recurrence; D013997:Time Factors
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole