This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Dimopoulos, G. Articles by Falagas, M. E. Search for Related Content PubMed Articles by Dimopoulos, G. Articles by Falagas, M. E.

---

LETTER TO THE EDITOR

Selection for Candida Non-albicans spp. After Fluconazole Use

Department of Intensive Care Unit; "Attikon" University Hospital; Alfa Institute of Biomedical Sciences (AIBS); Athens, Greece (Dimopoulos) Alfa Institute of Biomedical Sciences (AIBS); Athens, Greece; Department of Medicine, Tufts University School of Medicine; Boston, MA; Department of Medicine, Henry Dunant Hospital; Athens, Greece m.falagas{at}aibs.gr (Falagas)

In Response:

The issue raised by Vandijck et al. has important clinical implications because several studies have documented the trend for an increase of the proportion of non-albicans species among Candida isolates.1,2 In addition, Candida infections receive a continuously growing attention because of their overall considerable incidence in immunocompromised and immunocompetent patients and data showing considerable mortality directly attributable to them.3,4

It is noteworthy that several studies (including large multicenter studies and other studies including smaller samples of patients) failed to show a definitive association between azole usage and isolation of more fluconazole resistant Candida strains, while a recently published systematic review suggested that fluconazole prophylaxis increases the risk for colonization with fluconazole susceptible-dose dependent or resistant strains and the percentage of non-albicans Candida isolates without, however, affecting the risk of invasive disease with susceptible-dose dependent or resistant strains.5–7 On the other hand, other data emphasize the development of infections due to non-albicans species with innate (Candida glabrata, Candida krusei) or acquired (Candida dubliniensis) resistance to fluconazole as well as the cross-azole resistance among various Candida species isolates.8 Also, while data from in vitro studies and animal models suggest that non-albicans species (mainly Candida tropicalis and Candida glabrata) may have lower virulence compared with Candida albicans, clinicians are aware that strains of these species do have the ability to cause severe infections in humans (especially in neutropenic patients), sometimes with a fatal outcome.

REFERENCES

1. Dimopoulos G, Ntziora F, Rachiotis G, Armaganidis A, Falagas ME. Candida albicans versus non-albicans intensive care unit-acquired bloodstream infections: differences in risk factors and outcome. Anesth Analg 2008;106:523–9[Abstract/Free Full Text]
2. Samonis G, Kofteridis DP, Saloustros E, Giannopoulou KP, Ntziora F, Christidou A, Maraki S, Falagas ME. Candida albicans versus non-albicans bloodstream infection in patients in a tertiary hospital: an analysis of microbiological data. Scand J Infect Dis 2008;40:414–9[Medline]
3. Dimopoulos G, Karabinis A, Samonis G, Falagas ME. Candidemia in immunocompromised and immunocompetent critically ill patients: a prospective comparative study. Eur J Clin Microbiol Infect Dis 2007;26:377–84[Medline]
4. Falagas ME, Apostolou KE, Pappas VD. Attributable mortality of candidemia: a systematic review of matched cohort and case-control studies. Eur J Clin Microbiol Infect Dis 2006;25:419–25[Web of Science][Medline]
5. Ostrosky-Zeichner L, Rex JH, Pappas PG, Hamill RG, Larsen RA, Horowitz HW, Powderly WG, Hyslop N, Kauffman CA, Cleary J, Manjino JE, Lee J. Antifungal susceptibility survey of 2000 bloodstream Candida isolates in the United States. Antimicrob Agents Chemother 2003;47:3149–154[Abstract/Free Full Text]
6. Blot S, Janssens R, Claeys G, Hoste E, Buyle F, De Waele JJ, Peleman R, Vogelaers D, Vandewoude K. Effect of fluconazole consumption on long-term trends in candidal ecology. J Antimicrob Chemother 2006;58:474–7[Abstract/Free Full Text]
7. Brion LP, Uko SE, Goldman DL. Risk of resistance associated with fluconazole prophylaxis: systematic review. J Infect 2007;54:521–9[Medline]
8. Snydman DR. Shifting patterns in the epidemiology of nosocomial Candida infections. Chest 2003;123:500S–503S[Web of Science][Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Dimopoulos, G. Articles by Falagas, M. E. Search for Related Content PubMed Articles by Dimopoulos, G. Articles by Falagas, M. E.