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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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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.