Fluconazole-resistant Candida albicans after long-term suppressive therapy

Abstract

Candida albicans is generally considered to be susceptible, in vivo, to fluconazole. In the population infected with human immunodeficiency virus, recurrent bouts of oral and esophageal candidiasis have led to increasing use of fluconazole for long-term prophylaxis. With prolonged therapy, the issue of developing resistance emerges. We report a case of fluconazole-resistant C albicans esophagitis that developed after fluconazole was used for more than 600 days.

The Evolution ofCandidaSpecies and Fluconazole Susceptibility among Oral and Vaginal Isolates Recovered from Human Immunodeficiency Virus (HIV)–Seropositive and At‐Risk HIV‐Seronegative Women

“…There was no evidence of a progressive decrease in C. albicans susceptibility that occurred during follow-up. This observation was somewhat surprising, given the enormous attention directed at clinical refractory oropharyngeal candidiasis due to fluconazole-resistant C. albicans [19][20][21][22][23][24][25][26][27][28][29][30]. These conflicting results may reflect characteristics of the study cohort.…”

“…Fluconazole, a broad-spectrum azole antifungal agent, is an effective treatment for mucosal candidiasis, although exposure to fluconazole may result in mucosal colonization with Candida species that are less susceptible to antifungals or to the development of resistance among normally susceptible strains [2,3,6,[16][17][18][19][20][21][22][23][24][25][26][27][28][29]. Refractory clinical oropharyngeal and esophageal candidiasis due to azole-resistant Candida species has emerged and continues to be a major clinical problem in AIDS patients [30].…”

“…Although the molecular basis for fluconazole resistance in Candida species has been partially determined, factors that select for azole resistance are poorly understood. The single consistent factor associated with azole-resistant candidiasis is patient exposure to fluconazole [19,21,22,26,30]. The influence of other host factors and the contribution of colonization patterns by various Candida species on the development of resistance have not been adequately studied.…”

Emergence of Candida albicans fungemia during voriconazole therapy

“…1,2 However, several reports describing in vitro and clinical resistance to fluconazole developing during azole therapy have been published in the last years. 3,4 This concern have resulted in the continued search for new agents with increased potency against Candida. Voriconazole, a secondgeneration triazole, have demonstrated excellent potency and broad-spectrum activity against all Candida species either in vitro 5 and in vivo.…”

Oropharyngeal and Esophageal Candidiasis in Immunocompromised Patients: Treatment Issues

“…Moreover, resistance has been associated with the use of Having identified the procedures required to reduce interlaboratory variability, the subcommittee addressed the developfluconazole as a suppressive agent, both for long-term continuous suppressive therapy and short-term suppressive therapy ment of interpretive breakpoints for various organism-drug combinations. In their recent publication [83], members of the [72,73].…”