INFECTION DUE TO FLUCONAZOLE-RESISTANT CANDIDA IN PATIENTS WITH AIDS - PREVALENCE AND MICROBIOLOGY

A cross-sectional study was conducted to assess the prevalence and mic robiology of oral infection due to fluconazole-resistant Candida in pa tients with AIDS, Oral swab specimens for fungal cultures were obtaine d from 100 consecutive outpatients with CD4 lymphocyte counts of <200/ mm(3). At least one fungal organism demonstrating in vitro resistance to fluconazole (minimum inhibitory concentration, greater than or equa l to 8 mu g/mL) was isolated from 26 (41%) of 64 patients for whom cul tures were positive. When fluconazole-resistant C. albicans was isolat ed, in vitro resistance correlated with clinical thrush. None of 10 pa tients from whom only non-albicans species of Candida were isolated ha d active thrush. The patients from whom fluconazole-resistant Candida albicans was isolated had lower CD4 cell counts (median, 9/mm(3)), a g reater number of treated episodes of thrush (median, 4.5), and a great er median duration of prior fluconazole treatment (231 days) than did patients from whom fluconazole-susceptible C. albicans was isolated (m edian CD4 cell count, 58/mm(3) [P = .004]; median number of treated ep isodes of thrush, 2.0 [P = .001]; and median duration of prior flucona zole treatment, 10 days [P = .01]; respectively). In a multivariate an alysis, the number of episodes and duration of fluconazole therapy wer e independent predictors of resistance.