INCREASE IN CANDIDA-KRUSEI INFECTION AMONG PATIENTS WITH BONE-MARROW TRANSPLANTATION AND NEUTROPENIA TREATED PROPHYLACTICALLY WITH FLUCONAZOLE
INCREASE IN CANDIDA-KRUSEI INFECTION AMONG PATIENTS WITH BONE-MARROW TRANSPLANTATION AND NEUTROPENIA TREATED PROPHYLACTICALLY WITH FLUCONAZOLE
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DOI：
10.1056/nejm199110313251803
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发表时间：
1991-10-31
影响因子：
158.5
通讯作者：
SARAL, R
中科院分区：
文献类型：
--
作者：
WINGARD, JR;MERZ, WG;SARAL, R
背景1990年初，氟康唑被引入骨髓移植后作为预防性抗真菌剂。同年，克柔念珠菌成为骨髓移植患者的主要念珠菌病原体。为了确定氟康唑的引入是否与C。本文对1989 ~ 1990年在本研究中心接受骨髓移植（n = 296）或白血病（n = 167）的所有住院成人患者的医学、真菌学和尸检记录进行了回顾性研究。84名接受氟康唑预防性抗真菌治疗的患者中，C.与未接受氟康唑治疗的335例患者相比，克柔氏杆菌感染的发生率（8.3%对1.2%，P = 0.002），尽管播散性克柔氏杆菌的频率较低。白色念珠菌和C.热带感染（0对6.0%，P = 0.02）。11 C中的10个克柔氏菌感染由阿替霉素B和氟胞嘧啶的组合控制。C.定殖克柔比星在接受氟康唑治疗的患者中的发生率为40.5%，而在未接受氟康唑治疗的患者中仅为16.7%（P < 0.0001）。定植与预防性使用氟康唑（比值比，3.50; P < 0.001）和诺氟沙星（比值比，2.53; P = 0.04）独立相关。C.克柔氏菌对氟康唑体外不敏感。在播散性念珠菌感染的高危患者中，抑制细菌植物群和更常见的念珠菌病原体可能允许一些致病性较低但天然耐药的念珠菌菌种，如C. krusei，成为系统性病原体。
Background. In early 1990 fluconazole was introduced as a prophylactic antifungal agent after bone marrow transplantation. During the same year Candida krusei emerged as the chief candida pathogen among patients with bone marrow transplants.Methods. To determine whether there was a correlation between the introduction of fluconazole and the increased incidence of C. krusei, we conducted a retrospective study based on the medical, mycologic, and autopsy records of all adult inpatients who had undergone bone marrow transplantation (n = 296) or who had leukemia (n = 167) at the study center during 1989 and 1990.Results. The 84 patients who received antifungal prophylaxis with fluconazole had a sevenfold greater frequency of C. krusei infection than the 335 patients who did not receive fluconazole (8.3 percent vs. 1.2 percent, P = 0.002), despite having a lower frequency of disseminated C. albicans and C. tropicalis infections (0 vs. 6.0 percent, P = 0.02). Ten of the 11 C. krusei infections were controlled by a combination of amphotericin B and flucytosine. Colonization by C. krusei was found in 40.5 percent of the patients who received fluconazole but in only 16.7 percent of those who did not receive it (P < 0.0001). Colonization was independently associated with the prophylactic use of both fluconazole (odds ratio, 3.50; P < 0.001) and norfloxacin (odds ratio, 2.53; P = 0.04). C. krusei was not susceptible to fluconazole in vitro.Conclusions. In patients at high risk for disseminated candida infections, suppression of bacterial flora and the more common candida pathogens may permit some less pathogenic, but natively resistant candida species, such as C. krusei, to emerge as systemic pathogens.