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Abstract
Systemic yeast infections are a major cause of morbidity and mortality in severely
immunocompromised patients. The in vitro susceptibility to amphotericin B of 29 yeasts
causing fungemia was examined in 26 patients undergoing allogeneic or autologous bone
marrow transplantation and/or myelosuppressive chemotherapy. The minimal inhibitory
concentrations (MICs) of amphotericin B observed with blood isolates from these patients
were significantly higher than those observed with blood, sputum, or skin isolates
from non-immunocompromised patients (p <0.01). All episodes (10 of 10) of bloodstream
infection in immunocompromised patients caused by isolates with MICs greater than
0.8 μg/ml were fatal, versus eight of 17 episodes of bloodstream infection caused
by yeasts with MICs of 0.8 μg/ml or less (p = 0.04). Although 15 of 26 patients received
empiric treatment with amphotericin B before laboratory evidence of fungemia developed,
the amphotericin B susceptibilities of their isolates were not significantly different
from those of patients who had not received empiric amphotericin B treatment. It is
concluded that yeast fungemia in severely immunocompromised patients is often caused
by organisms resistant to the usual concentrations of amphotericin B obtainable in
vivo, and that this finding is clinically significant.
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References
- Fungemia with compromised host resistance: a study of 70 cases.Ann Intern Med. 1974; 80: 605-612
- Bacteremia and fungemia complicating neoplastic disease; a study of 364 cases.Am J Med. 1977; 62: 731-742
- Fungemia in the immunocompromised host: changing patterns, antigenemia, high mortality.Am J Med. 1981; 71: 363-370
- Fungemia in a cancer hospital: changing frequency, earlier onset, and results of therapy.Rev Infect Dis. 1985; 7: 646-655
- Severe candidal infections.in: Clinical perspective, immune defense mechanisms, and current concepts of therapy. 4th ed. Ann Intern Med. 89. 1978: 91-106
- Empiric antibiotic and antifungal therapy for cancer patients with prolonged fever and granulocytopenia.Am J Med. 1982; 72: 101-111
- Empiric amphotericin B therapy in patients with acute leukemia.Rev Infect Dis. 1985; 7: 619-624
- Approaching the controversies in antibacterial management of cancer patients.Am J Med. 1984; 76: 436-449
- Laboratory studies with antifungal agents: susceptibility tests and bioassays.in: 4th ed. Manual of clinical microbiology. American Society of Microbiology, Washington1985: 991-999
- HPLC measurement of amphotericin B serum levels in cancer patients.(abstr)in: Program and abstracts of the 27th Interscience Conference on Antimicrobial Agents and Chemotherapy. American Society of Microbiology, New York1987: 233
- Development of amphotericin B-resistant Candida tropicalis in a patient with defective leukocyte function.Am J Med Sci. 1978; 276: 77-92
- Development of resistance to amphotericin B in Candida lusitaniae infecting a human.Antimicrob Agents Chemother. 1979; 16: 123-126
- Isolation and characterization of a polyene-resistant variant of Candida tropicalis.J Clin Microbiol. 1979; 9: 677-680
- Incidence of polyene-resistant yeasts recovered from clinical specimens.Antimicrob Agents Chemother. 1980; 18: 158-163
- Fatal disseminated candidiasis due to amphotericin B resistant Candida guillermondii.Ann Intern Med. 1985; 102: 68-69
- Effect of ketoconazole on the fungicidal action of amphotericin B in Candida albicans.Antimicrob Agents Chemother. 1983; 23: 185-187
- Amphotericin B-induced oxidative damage and killing of Candida albicans.J Infect Dis. 1986; 154: 76-83
- The radiobiology of human cancer radiotherapy.University Park Press, Baltimore1978
- A general mechanism for microsomal activation of quinone anticancer agents to free radicals.Cancer Res. 1978; 38: 1745-1750
- Synergistic action of amphotericin B and 5-fluorocytosine for Candida species.in: 2nd ed. Proc Soc Exp Biol Med. 138. 1971: 571-574
- A comparison of amphotericin B alone and combined with flucytosine in the treatment of cryptococcal meningitis.N Engl J Med. 1979; 301: 126-131
- Successful treatment of Candida meningitis with amphotericin B and 5-fluorocytosine in combination.J Pediatr. 1976; 89: 1017-1019
- Combined treatment with amphotericin B and flucytosine in severe fungal infections.J Antimicrob Chemother. 1976; 2: 239-246
- Bone marrow toxicity associated with 5-fluorocytosine therapy.Antimicrob Agents Chemother. 1977; 11: 244-247
Article Info
Publication History
Accepted:
February 29,
1988
Received:
October 8,
1987
Footnotes
☆This work was supported in part by Grant AI-16228 from the Program in Medical Mycology and Training Grants AI-07172 and AI-07015 from the National Institute of Allergy and Infectious Diseases. This study was presented in part at the annual meeting of the American Federation for Clinical Research, May 2, 1986, in Washington, D.C.
Identification
Copyright
© 1988 Published by Elsevier Inc.
