Impact of Antifungal Prophylaxis on Colonization and Azole Susceptibility of Candida species.
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Impact of Antifungal Prophylaxis on Colonization and Azole Susceptibility of Candida species.
Antimicrob Agents Chemother. 2009 Sep 28;
Authors: Mann PA, McNicholas PM, Chau AS, Patel R, Mendrick C, Ullmann AJ, Cornely OA, Patino H, Black TA
Two large studies compared posaconazole vs. fluconazole or itraconazole for prophylaxis in subjects undergoing allogeneic hematopoietic stem cell transplantation or with acute myelogenous leukemia. To assess the impact of prophylaxis on colonization and development of resistance in yeasts, identification and susceptibility testing were performed on yeasts cultured at regular intervals from mouth/throat/stool samples. Prior to therapy 34-50% of subjects were colonized with yeasts. For all three drugs, the number of positive Candida albicans cultures decreased during drug therapy. In contrast, the proportion of subjects with positive C. glabrata cultures increased by two- and four-fold in the posaconazole and itraconazole arms, respectively. Likewise, in the fluconazole arm the proportion of subjects with positive C. krusei cultures increased two-fold. C. glabrata was the species that most frequently exhibited decreases in susceptibility and this trend did not differ significantly between the prophylactic regimens. For the subset of subjects with colonizing C. glabrata isolated at baseline and end of treatment approximately, 40% of isolates exhibited a >four-fold increase in MIC while on therapy. Molecular typing of C. albicans and C. glabrata isolates confirmed that the majority of the baseline and end of treatment isolates were closely related to suggesting that they were persistent colonizers and not newly acquired. Overall breakthrough infections by Candida species were very rare ( approximately 1%) and C. glabrata was the colonizing species most frequently associated with breakthrough infections.
PMID: 19786600 [PubMed - as supplied by publisher]