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Evolution
of Antifungal Susceptibility among Candida Species Isolates
Recovered from Human Immunodeficiency Virus-Infected Women Receiving
Fluconazole Prophylaxis [Vazquez JA et al. CID 2001;33:1069]
This is a CPCRA study to examine the problem of resistant Candida
recovered from women with HIV infection who receive fluconazole
(200 mg/week) as prophylaxis. There were 173 participants with CD4
counts <350 cells/mm3.
During the follow-up period that averaged ten months, there were
a total of 872 surveillance vaginal cultures for detection of Candida
species and isolates were tested for azole resistance. The results
showed that fluconazole recipients had a significant reduction in
rates of mucosal candidiasis (thrush or vaginitis). The frequency
of C. albicans resistant to fluconazole was just one isolate
in the fluconazole group and two in the control group; however,
there was a higher frequency of non-albicans Candida isolates
resistant to fluconazole in the former group (22 vs. 8). The difference
was not statistically significant. The results are summarized in
the table below:
| |
Fluconazole
200 mg/wk
n = 91 |
Placebo
n = 82
|
| Frequency
of candidiasis |
11
(12%) |
28
(34%) |
C.
albicans
Resistant fluconazole |
1
(1%) |
2
(2%) |
Non-albicans
Candida
Resistant fluconazole |
22
(25%) |
8
(12%) |
Comment: The estimated frequency of azole resistance by C.
albicans in persons with AIDS is not well defined, but in this
series it was two of 199 isolates and was not significantly greater
among those who received fluconazole prophylaxis. A possible explanation
for this is the regimen that was used, which was 200 mg/week. Despite
the lack of anticipated difference between the two groups, there was
a trend toward increased colonization rates with azole-resistant non-albicans
species.
posted
10/9/2001
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