Determinants for the Development of Oropharyngeal Colonization or Infection by Fluconazole-Resistant Candida Strains in HIV-Infected Patients |
| |
Authors: | M Masiá Canuto F Gutiérrez Rodero V Ortiz de la Tabla Ducasse I Hernández Aguado C Martín González A Sánchez Sevillano A Martín Hidalgo |
| |
Institution: | (1) Servicio de Medicina Interna, Unidad de Enfermedades Infecciosas, Hospital General Universitario de Elche, Partida de Huertos y Molinos s/n, 03202 Elche, Alicante, Spain e-mail: fgutierrezr@medynet.com, ES;(2) Sección de Microbiología, Hospital Universitario de San Juan, Alicante, Spain, ES;(3) Universidad Miguel Hernández, Elche, Alicante, Spain, ES |
| |
Abstract: | A point prevalence study to document oral yeast carriage was undertaken. Risk factors for the development of oropharyngeal
colonization or infection by fluconazole-resistant Candida strains in HIV-infected patients were investigated with a case-control design. Cases included all patients with fluconazole-resistant
strains (MIC≥64 μg/ml), and controls were those with susceptible (MIC≤8 μg/ml) or susceptible-dependent-upon-dose (MIC 16–32 μg/ml)
strains. One hundred sixty-eight Candida strains were isolated from 153 (88%) patients, 28 (16%) of whom had oropharyngeal candidiasis. Overall, 19 (12%) of the patients
harbored at least one resistant organism (MIC≥64 μg/ml). Among patients with resistant strains, tuberculosis (P<0.001), esophageal candidiasis (P=0.001), clinical thrush (P<0.001), and a CD4+ cell count <200/mm3 (P=0.03) were more frequent. These patients had also been treated more commonly with antituberculous drugs (adjusted odds ratio
OR] 6.13; 95% confidence interval CI] 2.11–17.80), ciprofloxacin (OR 6.0; 95% CI 1.23–29.26), fluconazole (OR 4.59; 95%
CI 1.55–13.52), and steroids (OR 4.13; 95% CI 1.11–15.39). Multivariate analysis showed that the determinants for fluconazole
resistance were therapy with antituberculous drugs (OR 3.61; 95% CI 1.08–12.07;P=0.03) and one of the following: previous tuberculosis (OR 3.53; 95% CI 1.08–14.57;P=0.03) or fluconazole exposure (OR 3.41; 95% CI 1.10–10.54). Findings from this study indicate that treatment with antituberculous
drugs, previous tuberculosis, and fluconazole exposure are the strongest determinants for development of oropharyngeal colonization
or infection by fluconazole-resistant Candida strains in HIV-infected patients. |
| |
Keywords: | |
本文献已被 SpringerLink 等数据库收录! |
|