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Journal of Clinical Microbiology, September 1998, p. 2690-2695, Vol. 36, No. 9
Department of Biochemistry and Molecular
Biology3 and
Division of Infectious
Diseases,
Received 16 March 1998/Returned for modification 11 April
1998/Accepted 13 June 1998
The fungicidal activity of amphotericin B (AmB) was quantitated for
several Candida species. Candida albicans and
C. tropicalis were consistently susceptible to AmB, with
less than 1% survivors after 6 h of exposure to AmB. C. parapsilosis and variants of C. lusitaniae and
C. guilliermondii were the most resistant, demonstrating 50 to 90% survivors in this time period and as high as 1% survival after
a 24-h exposure time. All Candida species were killed
(<1% survivors) after 24 h of exposure to AmB. In contrast,
overnight exposure to either fluconazole or itraconazole resulted in
pronounced increases in resistance to subsequent exposures to AmB. Most
dramatically, C. albicans was able to grow in AmB cultures
after azole preexposure. Several other Candida species did
not grow in AmB but showed little or no reduction in viability after up
to 24 h in AmB. Depending on the growth conditions,
Candida cells preexposed to azoles may retain AmB
resistance for days after the azoles have been removed. If this in
vitro antagonism applies to the clinical setting, treatment of patients
with certain antifungal combinations may not be beneficial. The ability
of some Candida isolates to survive transient exposures to
AmB was not reflected in the in vitro susceptibility changes as
measured by standard MIC assays. This finding should be considered in
studies attempting to correlate patient outcome with in vitro susceptibilities of clinical fungal isolates. Patients who fail to
respond to AmB may be infected with isolates that are classified as
susceptible by standard in vitro assays but that may be resistant to
transient antifungal exposures which may be more relevant in the
clinical setting.
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.
Stable Phenotypic Resistance of Candida
Species to Amphotericin B Conferred by Preexposure to Subinhibitory
Levels of Azoles
*
Corresponding author. Mailing address: Harper Hospital,
3990 John R, 4 Yellow Center, Detroit, MI 48201. Phone: (313) 745-9649. Fax: (313) 993-0302. E-mail: jvazquez{at}oncgate.roc.wayne.edu.
Journal of Clinical Microbiology, September 1998, p. 2690-2695, Vol. 36, No. 9
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.
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