title: Selection of Candida glabrata strains with reduced susceptibility to azoles in four liver transplant patients with invasive candidiasis.
abstract: The cases of four liver transplant recipients who developed invasive candidiasis (2 cholangitis, 1 perihepatic abscess, 1 candidemia) due to azole-resistant, Candida 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 patient Candida 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 micrograms/ml in all cases; itraconazole MICs were 16, 2, 1, and 2 micrograms/ml, respectively. The potential role of Candida species other than albicans in these patients after administration of azole agents is discussed.
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases, Ramón y Cajal Hospital, Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Fortún
authors.forename: A
authors.initials: A
authors.lastname: López-San Román
authors.forename: J J
authors.initials: JJ
authors.lastname: Velasco
authors.forename: A
authors.initials: A
authors.lastname: Sánchez-Sousa
authors.forename: E
authors.initials: E
authors.lastname: de Vicente
authors.forename: J
authors.initials: J
authors.lastname: Nuño
authors.forename: C
authors.initials: C
authors.lastname: Quereda
authors.forename: R
authors.initials: R
authors.lastname: Bárcena
authors.forename: G
authors.initials: G
authors.lastname: Monge
authors.forename: A
authors.initials: A
authors.lastname: Candela
authors.forename: A
authors.initials: A
authors.lastname: Honrubia
authors.forename: A
authors.initials: A
authors.lastname: Guerrero
mesh_terms: D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002177:Candidiasis / Q000175:diagnosis / Q000188:drug therapy*; D004352:Drug Resistance, Microbial; D017809:Fatal Outcome; D015725:Fluconazole / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D017964:Itraconazole / Q000008:administration & dosage / Q000627:therapeutic use*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged
chemical_list: D000935:Antifungal Agents; D017964:Itraconazole; D015725:Fluconazole