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Isolation and characterization of fluconazole- and amphotericin B-resistant Candida albicans from blood of two patients with leukemia.


Antimicrob Agents Chemother. 1997 Jan;41(1):196-9. Unique Identifier :

Infections with fluconazole-resistant Candida albicans isolate have rarely been described in clinical settings other than oropharyngeal candidiasis in patients with late-stage AIDS. We report on two patients with leukemia who developed fungemia caused by fluconazole-resistant C. albicans after receiving fluconazole prophylaxis (400 mg/day) and empiric amphotericin B therapy (0.5 mg/kg of body weight per day). The fluconazole MICs for the isolates were > or = 64 micrograms/ml, and the isolates were resistant to other azoles and had membrane sterol changes consistent with a mutation in the delta 5,6-sterol desaturase gene. The lack of ergosterol in the cytoplasmic membrane of the fluconazole-resistant strains also imparted resistance to amphotericin B. Both patients were successfully treated with high-dose amphotericin B (1 to 1.25 mg/kg/day) and flucytosine 150 mg/kg/day).

*Amphotericin B/THERAPEUTIC USE *Antifungal Agents/THERAPEUTIC USE *Candida albicans/DRUG EFFECTS *Candidiasis/DRUG THERAPY *Fluconazole/THERAPEUTIC USE *Leukemia, Lymphocytic, Acute/COMPLICATIONS *Leukemia, Myelocytic, Acute/COMPLICATIONS


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