FUNGAL COLONIZATION AND FLUCONAZOLE THERAPY IN ACUTE-LIVER-DISEASE

Background/Aims: Fungal infection, particulary with Candida spp., has been identified as an important cause of morbidity and mortality in pa tients with acute liver failure. Fungal colonisation of superficial mu cosal sites usually precedes invasive infection. We investigated colon isation patterns in patients with acute liver disease receiving flucon azole therapy in order to investigate the possibility of emergence of fluconazole-resistant C. albicans or other species. Methods: During a 6-month study period, we studied an patients referred to our unit with acute liver disease by twice-weekly sampling and mycological analysis of specimens from superficial mucosal and other sites as appropriate. Patients were treated with prophylactic antimicrobials including 100 mg fluconazole daily in accordance with our usual protocol. Results: T wenty-two patients with acute liver disease were studied, eight of who m underwent transplantation. Eighteen patients were colonised by fungi at presentation, and six developed secondary colonisation during fluc onazole therapy. Four of these patients (all transplanted) became colo nised by resistant species; one of these was Aspergillus fumigatus, wh ich led to death. There were no other invasive fungal infections ident ified during the study period, and no fluconazole-resistant C. albican s were identified. Conclusions: Resistance to fluconazole is unlikely to develop in C. albicans during short-term fluconazole prophylaxis in acute liver disease, and in this study we did not find evidence of in vasive disease from other Candida spp. during fluconazole therapy. How ever, in patients at particularly high risk, other strategies are requ ired to prevent infection with Aspergillus spp.