ISOLATION OF FLUCONAZOLE-RESISTANT CANDIDA-ALBICANS FROM HUMAN IMMUNODEFICIENCY VIRUS-NEGATIVE PATIENTS NEVER TREATED WITH AZOLES

Isolation of fluconazole-resistant strains of Candida species from hum an immunodeficiency virus (HIV)-infected patients after repeated or co ntinuous courses of treatment has been reported with increasing freque ncy. During 1991-1992, MICs of fluconazole for 139 Candida albicans is olates from our institution were bimodally distributed: 102 strains we re susceptible (MICs, less than or equal to 4 mu g/mL) and 37 were res istant (MICs, greater than or equal to 8 mu g/mL). There was incomplet e cross-resistance between fluconazole and ketoconazole or miconazole, and there was no cross-resistance between azoles and amphotericin B o r flucytosine. Twenty of the 37 fluconazole-resistant strains were iso lated from 17 HIV-negative patients, some with systemic infections, wh o had never been treated with azoles. There were no differences in cha racteristics or risk factors for those patients as compared with those for an equal number of HIV-negative patients from whom fluconazole-su sceptible strains were isolated. Among patients with systemic infectio n, 6 (50%) of 12 with infection caused by fluconazole-resistant strain s survived and 11 (69%) of 16 with infection caused by fluconazole-sus ceptible strains survived (P = .54). Survival was not found to be rela ted to treatment regimen, but the number of patients was small. The em ergence of fluconazole-resistant C. albicans among HIV-negative patien ts never exposed to azoles is of concern,