Marr K A, Seidel K, White T C, Bowden R A
Fred Hutchinson Cancer Research Center Program in Infectious Diseases, University of Washington Department of Medicine, Seattle, Washington, USA.
J Infect Dis. 2000 Jan;181(1):309-16. doi: 10.1086/315193.
The prophylactic use of fluconazole is common in blood and marrow transplant (BMT) recipients. To evaluate how fluconazole has influenced the development of azole resistance and candidemia, weekly mouthwashings were done, and fluconazole susceptibility was determined for 1475 colonizing and invasive isolates obtained from patients undergoing BMT. Of 585 patients, 256 (44%) were colonized with Candida species during the course of BMT. Of these, 136 patients (53%) had at least 1 mouthwashing sample that yielded Candida species other than C. albicans on culture. Only 4.6% of patients developed candidemia. Overall, C. albicans was the most common colonizing isolate, but it caused only 7% of cases of candidemia. About 5% of colonizing C. albicans strains and 100% (2 of 2) invasive C. albicans strains were fluconazole-resistant. Colonization, cytomegalovirus disease, and bacteremia are risk factors for the development of candidemia. The use of prophylactic fluconazole is associated with a low incidence of candidemia and attributable mortality, despite colonization with azole-resistant Candida species in BMT recipients.
氟康唑的预防性使用在血液和骨髓移植（BMT）受者中很常见。为了评估氟康唑如何影响唑类耐药性和念珠菌血症的发生，我们进行了每周一次的口腔冲洗，并对从接受BMT的患者中获得的1475株定植和侵袭性分离株进行了氟康唑敏感性测定。在585例患者中，256例（44%）在BMT过程中被念珠菌属定植。其中，136例患者（53%）至少有1份口腔冲洗样本在培养时分离出白色念珠菌以外的念珠菌属。只有4.6%的患者发生了念珠菌血症。总体而言，白色念珠菌是最常见的定植分离株，但它仅导致7%的念珠菌血症病例。约5%的定植白色念珠菌菌株和100%（2/2）的侵袭性白色念珠菌菌株对氟康唑耐药。定植、巨细胞病毒病和菌血症是念珠菌血症发生的危险因素。尽管BMT受者中存在对唑类耐药的念珠菌属定植，但预防性使用氟康唑与念珠菌血症的低发病率和可归因死亡率相关。
