Nolte F S, Parkinson T, Falconer D J, Dix S, Williams J, Gilmore C, Geller R, Wingard J R
Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Antimicrob Agents Chemother. 1997 Jan;41(1):196-9. doi: 10.1128/AAC.41.1.196.
Infections with fluconazole-resistant Candida albicans isolate have rarely been described in clinical settings other than oropharyngeal candidiasis in patients with late-stage AIDS. We report on two patients with leukemia who developed fungemia caused by fluconazole-resistant C. albicans after receiving fluconazole prophylaxis (400 mg/day) and empiric amphotericin B therapy (0.5 mg/kg of body weight per day). The fluconazole MICs for the isolates were > or = 64 micrograms/ml, and the isolates were resistant to other azoles and had membrane sterol changes consistent with a mutation in the delta 5,6-sterol desaturase gene. The lack of ergosterol in the cytoplasmic membrane of the fluconazole-resistant strains also imparted resistance to amphotericin B. Both patients were successfully treated with high-dose amphotericin B (1 to 1.25 mg/kg/day) and flucytosine (150 mg/kg/day).
除了晚期艾滋病患者的口咽念珠菌病外，在其他临床环境中很少有关于耐氟康唑白色念珠菌分离株感染的报道。我们报告了两名白血病患者，他们在接受氟康唑预防治疗（400毫克/天）和经验性两性霉素B治疗（0.5毫克/千克体重/天）后，发生了由耐氟康唑白色念珠菌引起的真菌血症。分离株对氟康唑的最低抑菌浓度≥64微克/毫升，对其他唑类耐药，且膜固醇变化与δ5,6-固醇去饱和酶基因突变一致。耐氟康唑菌株细胞质膜中麦角固醇的缺乏也使其对两性霉素B产生耐药性。两名患者均接受高剂量两性霉素B（1至1.25毫克/千克/天）和氟胞嘧啶（150毫克/千克/天）治疗成功。
