Wingard J R, Merz W G, Rinaldi M G, Miller C B, Karp J E, Saral R
Johns Hopkins Oncology Center, Baltimore, Maryland 21205.
Antimicrob Agents Chemother. 1993 Sep;37(9):1847-9. doi: 10.1128/AAC.37.9.1847.
Because the use of fluconazole prophylaxis had been associated with an increased rate of Candida krusei infections at The John Hopkins Oncology Center, early empiric amphotericin B plus flucytosine were given to febrile neutropenic patients colonized by C. krusei. By this practice, the proportion of fungemias attributable to C. krusei was low (12.5%) in patients receiving fluconazole over a 6-month interval. However, Torulopsis (Candida) glabrata assumed a much higher proportion of fungemias (75%) among patients receiving fluconazole. In vitro susceptibility testing combined with this clinical experience suggests that some T. glabrata isolates are not susceptible to fluconazole and can cause breakthrough infections in patients receiving fluconazole.
由于在约翰霍普金斯肿瘤中心，氟康唑预防用药与克鲁斯念珠菌感染率增加有关，因此对于定植有克鲁斯念珠菌的发热性中性粒细胞减少患者，早期给予经验性两性霉素B加氟胞嘧啶治疗。通过这种做法，在6个月期间接受氟康唑治疗的患者中，由克鲁斯念珠菌引起的真菌血症比例较低（12.5%）。然而，在接受氟康唑治疗的患者中，光滑念珠菌（念珠菌属）在真菌血症中所占比例要高得多（75%）。体外药敏试验结合这一临床经验表明，一些光滑念珠菌分离株对氟康唑不敏感，可在接受氟康唑治疗的患者中引起突破性感染。
