Miller Christopher D, Lomaestro Ben W, Park Steven, Perlin David S
Pharmacy Practice Department, Albany College of Pharmacy, Albany, New York 12208-3492, USA.
Pharmacotherapy. 2006 Jun;26(6):877-80. doi: 10.1592/phco.26.6.877.
Candida esophagitis, a defining illness of acquired immunodeficiency syndrome (AIDS), requires systemic antifungal therapy. Candida albicans can become resistant to commonly administered azole antifungal agents. An attractive alternative is caspofungin, an echinocandin antifungal that has generally displayed predictable activity against C. albicans. We report the case of a 29-year-old woman with AIDS who developed recurrent esophagitis caused by a strain of C. albicans that showed reduced susceptibility to caspofungin (elevated minimum inhibitory concentration of 8 mg/L). Analysis of the strain revealed that it contained a serine-to-proline substitution at position 645 in the FKS1 gene. Clinicians who prescribe caspofungin to treat esophagitis caused by C. albicans should recognize the potential risk, albeit slight, for acquired resistance to caspofungin and possibly other echinocandin antifungal agents in the face of persistent disease. In patients who are refractory or unresponsive to caspofungin therapy, susceptibility testing and/or alternative therapy should be considered.
念珠菌食管炎是获得性免疫缺陷综合征（AIDS）的一种典型疾病，需要进行全身抗真菌治疗。白色念珠菌可能会对常用的唑类抗真菌药物产生耐药性。卡泊芬净是一种颇具吸引力的替代药物，它是一种棘白菌素类抗真菌药，通常对白色念珠菌表现出可预测的活性。我们报告了一例29岁的艾滋病女性病例，该患者因一株对卡泊芬净敏感性降低（最低抑菌浓度升高至8mg/L）的白色念珠菌而发生复发性食管炎。对该菌株的分析显示，其FKS1基因第645位存在丝氨酸到脯氨酸的替换。临床医生在开具卡泊芬净治疗白色念珠菌引起的食管炎时，应认识到面对持续性疾病时获得对卡泊芬净以及可能对其他棘白菌素类抗真菌药物耐药的潜在风险，尽管这种风险很小。对于卡泊芬净治疗无效或无反应的患者，应考虑进行药敏试验和/或采用替代疗法。
