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Candida glabrata fungemia in transplant patients receiving voriconazole after fluconazole.

Publication ,  Journal Article
Alexander, BD; Schell, WA; Miller, JL; Long, GD; Perfect, JR
Published in: Transplantation
September 27, 2005

The clinical impact of voriconazole resistance in Candida glabrata is not well described. Five hematopoietic stem cell transplant recipients that developed breakthrough Candida glabrata bloodstream infections while receiving voriconazole are described and the clinical management and susceptibility profiles of their isolates are reported. All patients were markedly immunosuppressed, and in all cases, voriconazole use was preceded by prolonged fluconazole exposure (median 60 days); median voriconazole exposure prior to candidemia was 48 days. Isolates from 4 patients were shown to be resistant to fluconazole and itraconazole when tested in vitro; these same isolates had MICs to voriconazole and posaconazole > or = 2 microg/ml. Clinical failure to voriconazole may result from deficits in host defense, retained infected foci, and adaptation of the organism to environmental pressures, the specific sequence and mechanisms of which warrant further study. Clinicians must maintain a high index of suspicion for these infections in highly susceptible hosts despite voriconazole therapy, particularly when voriconazole use is preceded by prolonged fluconazole exposure.

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Published In

Transplantation

DOI

ISSN

0041-1337

Publication Date

September 27, 2005

Volume

80

Issue

6

Start / End Page

868 / 871

Location

United States

Related Subject Headings

  • Voriconazole
  • Triazoles
  • Surgery
  • Stem Cell Transplantation
  • Pyrimidines
  • Microbial Sensitivity Tests
  • Male
  • Leukemia
  • Humans
  • Fungemia
 

Citation

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Alexander, B. D., Schell, W. A., Miller, J. L., Long, G. D., & Perfect, J. R. (2005). Candida glabrata fungemia in transplant patients receiving voriconazole after fluconazole. Transplantation, 80(6), 868–871. https://doi.org/10.1097/01.tp.0000173771.47698.7b
Alexander, Barbara D., Wiley A. Schell, Jackie L. Miller, Gwynn D. Long, and John R. Perfect. “Candida glabrata fungemia in transplant patients receiving voriconazole after fluconazole.Transplantation 80, no. 6 (September 27, 2005): 868–71. https://doi.org/10.1097/01.tp.0000173771.47698.7b.
Alexander BD, Schell WA, Miller JL, Long GD, Perfect JR. Candida glabrata fungemia in transplant patients receiving voriconazole after fluconazole. Transplantation. 2005 Sep 27;80(6):868–71.
Alexander, Barbara D., et al. “Candida glabrata fungemia in transplant patients receiving voriconazole after fluconazole.Transplantation, vol. 80, no. 6, Sept. 2005, pp. 868–71. Pubmed, doi:10.1097/01.tp.0000173771.47698.7b.
Alexander BD, Schell WA, Miller JL, Long GD, Perfect JR. Candida glabrata fungemia in transplant patients receiving voriconazole after fluconazole. Transplantation. 2005 Sep 27;80(6):868–871.

Published In

Transplantation

DOI

ISSN

0041-1337

Publication Date

September 27, 2005

Volume

80

Issue

6

Start / End Page

868 / 871

Location

United States

Related Subject Headings

  • Voriconazole
  • Triazoles
  • Surgery
  • Stem Cell Transplantation
  • Pyrimidines
  • Microbial Sensitivity Tests
  • Male
  • Leukemia
  • Humans
  • Fungemia