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Infection due to fluconazole-resistant Candida in patients with AIDS: prevalence and

By Janine R. Maenza, William G. Merz, Mark J. Romagnoli, Jeanne C. Keruly, Richard D. Moore and Joel E. Gallant


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/mm 3. At least one fungal organism demonstrating in vitro resistance to fluconazole (minimum inhibitory concentration,,ug/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. Mucosal candidiasis affects up to 90 % of patients with AID

Year: 1997
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