ISOLATION AND CHARACTERIZATION OF FLUCONAZOLE-RESISTANT AND AMPHOTERICIN-B-RESISTANT CANDIDA-ALBICANS FROM BLOOD OF 2 PATIENTS WITH LEUKEMIA

Infections with fluconazole-resistant Candida albicans isolates have r arely been described in clinical settings other than oropharyngeal can didiasis in patients with late-stage AIDS. We report on two patients w ith leukemia who developed fungemia caused by fluconazole-resistant C. albicans after receiving fluconazole prophylaxis (400 mg/day) and emp iric amphotericin B therapy (0.5 mg/kg of body weight per day). The fl uconazole MICs for the isolates were greater than or equal to 64 mu g/ ml, and the isolates were resistant to other azoles and had membrane s terol changes consistent with a mutation in the Delta(5,6)-sterol desa turase gene, The lack of ergosterol in the cytoplasmic membrane of the fluconazole-resistant strains also imparted resistance to amphoterici n B. Both patients were successfully treated with high-dose amphoteric in B (1 to 1.25 mg/kg/day) and flucytosine (150 mg/kg/day).