ASSOCIATION OF TORULOPSIS-GLABRATA INFECTIONS WITH FLUCONAZOLE PROPHYLAXIS IN NEUTROPENIC BONE-MARROW TRANSPLANT PATIENTS

Because the use of fluconazole prophylaxis had been associated with an increased rate of Candida krusei infections at The Johns Hopkins Onco logy Center, early empiric amphotericin B plus flucytosine were given to febrile neutropenic patients colonized by C. krusei. By this practi ce, the proportion of fungemias attributable to C. krusei was low (12. 5%) in patients receiving fluconazole over a 6-month interval. However , Torulopsis (Candida) glabrata assumed a much higher proportion of fu ngemias (75%) among patients receiving fluconazole. In vitro susceptib ility testing combined with this clinical experience suggests that som e T. glabrata isolates are not susceptible to fluconazole and can caus e breakthrough infections in patients receiving fluconazole.