This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowReprints and Permissions
Right arrow Copyright Information
Right arrow Books from ASM Press
Right arrow MicrobeWorld
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Panackal, A. A.
Right arrow Articles by Marr, K. A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Panackal, A. A.
Right arrow Articles by Marr, K. A.

 Previous Article  |  Next Article 

Journal of Clinical Microbiology, May 2006, p. 1740-1743, Vol. 44, No. 5
0095-1137/06/$08.00+0     doi:10.1128/JCM.44.5.1740-1743.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.

Clinical Significance of Azole Antifungal Drug Cross-Resistance in Candida glabrata

Anil A. Panackal,1,2 Jennifer L. Gribskov,1 Janet F. Staab,1 Katherine A. Kirby,1 Michael Rinaldi,3 and Kieren A. Marr1,2,4*

Program in Infectious Diseases, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington,1 Departments of Medicine,2 Microbiology, University of Washington, Seattle, Washington,4 Fungus Testing Laboratory, University of Texas, San Antonio, Texas3

Received 3 February 2006/ Returned for modification 22 February 2006/ Accepted 27 February 2006

Candida glabrata, which can become resistant to fluconazole, is a common cause of bloodstream infection. This study was performed to determine the significance of cross-resistance to new azole drugs among C. glabrata isolates recovered as a cause of infection in azole-treated hematopoietic stem cell transplant (HSCT) recipients. Seven cases of invasive candidiasis caused by C. glabrata occurred in HSCT recipients who were receiving azole therapy between January 2000 and December 2004 in our institution. Case characteristics were ascertained. Sequential colonizing and invasive isolates were examined to determine susceptibilities to fluconazole, itraconazole, and voriconazole, and molecular relatedness by restriction fragment length polymorphism (RFLP) analysis. Twenty-three C. glabrata isolates were recovered from 4 patients who developed candidemia while receiving fluconazole and three patients who developed candidemia while receiving voriconazole. The mode MICs of fluconazole, itraconazole, and voriconazole for these isolates were ≥64 µg/ml (range, 4 to ≥64 µg/ml), 2 µg/ml (range, 0.25 to ≥16 µg/ml), and 1 µg/ml (range, 0.03 to ≥16 µg/ml), respectively. Kendall tau b correlation coefficients demonstrated significant associations between the MICs of voriconazole with fluconazole (P = 0.005) and itraconazole (P = 0.008). Colonizing and invasive isolates exhibiting variable susceptibilities had similar RFLP patterns. These observations suggest that C. glabrata exhibits considerable clinically significant cross-resistance between older azole drugs (fluconazole and itraconazole) and voriconazole. Caution is advised when considering voriconazole therapy for C. glabrata candidemia that occurs in patients with extensive prior azole drug exposure.

* Corresponding author. Mailing address: Fred Hutchinson Cancer Research Center, University of Washington, Seattle, 1100 Fairview Ave., D3-100, Seattle, WA 98109. Phone: (206) 667-6702. Fax: (206) 667-4411. E-mail: kmarr{at}fhcrc.org.

Journal of Clinical Microbiology, May 2006, p. 1740-1743, Vol. 44, No. 5
0095-1137/06/$08.00+0     doi:10.1128/JCM.44.5.1740-1743.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.



This article has been cited by other articles:

  • Mandras, N., Tullio, V., Allizond, V., Scalas, D., Banche, G., Roana, J., Robbiano, F., Fucale, G., Malabaila, A., Cuffini, A. M., Carlone, N. (2009). In Vitro Activities of Fluconazole and Voriconazole against Clinical Isolates of Candida spp. Determined by Disk Diffusion Testing in Turin, Italy. Antimicrob. Agents Chemother. 53: 1657-1659 [Abstract] [Full Text]  
  • Tumbarello, M., Sanguinetti, M., Trecarichi, E. M., La Sorda, M., Rossi, M., de Carolis, E., de Gaetano Donati, K., Fadda, G., Cauda, R., Posteraro, B. (2008). Fungaemia caused by Candida glabrata with reduced susceptibility to fluconazole due to altered gene expression: risk factors, antifungal treatment and outcome. J Antimicrob Chemother 62: 1379-1385 [Abstract] [Full Text]  
  • Ruan, S.-Y., Chu, C.-C., Hsueh, P.-R. (2008). In Vitro Susceptibilities of Invasive Isolates of Candida Species: Rapid Increase in Rates of Fluconazole Susceptible-Dose Dependent Candida glabrata Isolates. Antimicrob. Agents Chemother. 52: 2919-2922 [Abstract] [Full Text]  
  • Spreghini, E., Maida, C. M., Tomassetti, S., Orlando, F., Giannini, D., Milici, M. E., Scalise, G., Barchiesi, F. (2008). Posaconazole against Candida glabrata Isolates with Various Susceptibilities to Fluconazole. Antimicrob. Agents Chemother. 52: 1929-1933 [Abstract] [Full Text]  
  • Lortholary, O., Dannaoui, E., Raoux, D., Hoinard, D., Datry, A., Paugam, A., Poirot, J.-L., Lacroix, C., Dromer, F., the YEASTS Group, (2007). In Vitro Susceptibility to Posaconazole of 1,903 Yeast Isolates Recovered in France from 2003 to 2006 and Tested by the Method of the European Committee on Antimicrobial Susceptibility Testing. Antimicrob. Agents Chemother. 51: 3378-3380 [Abstract] [Full Text]  
  • Pfaller, M. A., Diekema, D. J., Gibbs, D. L., Newell, V. A., Meis, J. F., Gould, I. M., Fu, W., Colombo, A. L., Rodriguez-Noriega, E., and the Global Antifungal Surveillance Group, (2007). Results from the ARTEMIS DISK Global Antifungal Surveillance Study, 1997 to 2005: an 8.5-Year Analysis of Susceptibilities of Candida Species and Other Yeast Species to Fluconazole and Voriconazole Determined by CLSI Standardized Disk Diffusion Testing. J. Clin. Microbiol. 45: 1735-1745 [Abstract] [Full Text]  
  • Li, L., Redding, S., Dongari-Bagtzoglou, A. (2007). Candida glabrata, an Emerging Oral Opportunistic Pathogen. JDR 86: 204-215 [Abstract] [Full Text]  
  • Pfaller, M. A., Diekema, D. J. (2007). Epidemiology of Invasive Candidiasis: a Persistent Public Health Problem. Clin. Microbiol. Rev. 20: 133-163 [Abstract] [Full Text]  
  • Pfaller, M. A., Messer, S. A., Boyken, L., Rice, C., Tendolkar, S., Hollis, R. J., Diekema, D. J. (2007). Use of Fluconazole as a Surrogate Marker To Predict Susceptibility and Resistance to Voriconazole among 13,338 Clinical Isolates of Candida spp. Tested by Clinical and Laboratory Standards Institute-Recommended Broth Microdilution Methods. J. Clin. Microbiol. 45: 70-75 [Abstract] [Full Text]  
  • Garcia-Vidal, C., Carratala, J., Bennett, J. E. (2006). Echinocandins for Candidemia. NEJM 355: 2791-2792 [Full Text]  
  • Cota, J., Carden, M., Graybill, J. R., Najvar, L. K., Burgess, D. S., Wiederhold, N. P. (2006). In Vitro Pharmacodynamics of Anidulafungin and Caspofungin against Candida glabrata Isolates, Including Strains with Decreased Caspofungin Susceptibility. Antimicrob. Agents Chemother. 50: 3926-3928 [Abstract] [Full Text]  


Copyright © 2009 by the American Society for Microbiology.   For an alternate route to Journals.ASM.org, visit: http://intl-journals.asm.org | More Info»