Nosocomial fungemia due to amphotericin B-resistant Candida spp. in three pediatric patients after previous neurosurgery for brain tumors.
Amphotericin B (AmB) resistance in Candida spp. is very rare. Three cases of fungemia, due to amphotericin B-resistant Candida spp. in pediatric patients after previous neurosurgery for brain tumors, are reported. The Candida strains - one C. guillermondii, one C. lusitaniae, and one C. parapsilosis - showed minimum inhibitory concentrations (MICs) to AmB of 2-4 microg/ml. Two of the three patients had been pretreated with AmB for 5-11 days. All three patients were successfully treated with intravenous fluconazole (6-10 mg/kg per day) for 16-28 days, and all survived. Despite AmB resistance in Candida spp. being very rare, C. lusitaniae, C. guillermondii, and C. parapsilosis isolates in documented infections should be tested for AmB resistance, mainly in patients not responding to therapy with AmB.
Kovacicova
G
G
School of Public Health, University of Trnava, Trnava, Slovak Republic.
Hanzen
J
J
Pisarcikova
M
M
Sejnova
D
D
Horn
J
J
Babela
R
R
Svetlansky
I
I
Lovaszova
M
M
Gogova
M
M
Krcmery
V
V
D000293:Adolescent; D000666:Amphotericin B / Q000494:pharmacology* / Q000627:therapeutic use; D000935:Antifungal Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000150:complications / Q000601:surgery*; D002175:Candida / Q000187:drug effects* / Q000302:isolation & purification; D002177:Candidiasis / Q000188:drug therapy / Q000382:microbiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003399:Craniotomy; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology*; D004352:Drug Resistance, Microbial; D004866:Equipment Contamination; D015725:Fluconazole / Q000627:therapeutic use; D016469:Fungemia / Q000188:drug therapy / Q000382:microbiology*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D008826:Microbial Sensitivity Tests; D011183:Postoperative Complications / Q000188:drug therapy / Q000382:microbiology*; D018154:Slovakia; D013045:Species Specificity; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects
D000935:Antifungal Agents; D000666:Amphotericin B; D015725:Fluconazole