Martins M D, Lozano-Chiu M, Rex J H
Department of Internal Medicine, University of Texas Medical School, Houston, USA.
Clin Infect Dis. 1997 Oct;25(4):843-6. doi: 10.1086/515554.
To estimate the prevalence of both clinically evident and asymptomatic carriage of fluconazole-resistant Candida, we prospectively surveyed 128 adults infected with human immunodeficiency virus (HIV). The patients had an average CD4 cell count of 206/mm3. Ninety-seven isolates of Candida were obtained from the oropharynx of 82 patients (64%). Of these 82 patients, 76% carried C. albicans alone; 18%, both albicans and non-albicans isolates; and 6%, non-albicans species alone. Oropharyngeal candidiasis was evident in only 38 (46%) of the 82 patients for whom a culture was positive and was never seen unless C. albicans was present. When MICs were measured by using the National Committee for Clinical Laboratory Standards M27-T methodology and grouped by using recently proposed breakpoints, we found that eight of the 38 patients with oropharyngeal candidiasis and six of the 44 patients who were asymptomatically colonized carried C. albicans isolates resistant to fluconazole (MIC, > or = 64 micrograms/mL); estimated rates of carriage were 21% (95% confidence interval, 10%-37%) and 14% (95% confidence interval, 5%-27%), respectively. Carriage of resistant isolates of C. albicans by HIV-infected adults is more common than previously suspected, and clinicians should be alert to the possible need for either higher doses of fluconazole or alternative treatment modalities.
为评估耐氟康唑念珠菌临床显性感染及无症状携带的患病率，我们对128例感染人类免疫缺陷病毒（HIV）的成人进行了前瞻性调查。这些患者的平均CD4细胞计数为206/mm³。从82例患者（64%）的口咽部获得了97株念珠菌分离株。在这82例患者中，76%仅携带白色念珠菌；18%同时携带白色念珠菌和非白色念珠菌分离株；6%仅携带非白色念珠菌。在82例培养阳性的患者中，仅38例（46%）有口咽部念珠菌病，且除非有白色念珠菌存在，否则从未见过口咽部念珠菌病。当采用美国国家临床实验室标准委员会M27 - T方法测定最低抑菌浓度（MIC）并根据最近提出的断点进行分组时，我们发现，38例口咽部念珠菌病患者中有8例以及44例无症状定植患者中有6例携带对氟康唑耐药的白色念珠菌分离株（MIC，≥64微克/毫升）；估计携带率分别为21%（95%置信区间，10% - 37%）和14%（95%置信区间，5% - 27%）。HIV感染成人中白色念珠菌耐药分离株的携带情况比之前怀疑的更为常见，临床医生应警惕可能需要更高剂量的氟康唑或其他替代治疗方式。
