A retrospective Evaluation of fluconazole for the treatment of Candida glabrata fungemia

Variation in Susceptibility of Bloodstream Isolates ofCandida glabratato Fluconazole According to Patient Age and Geographic Location in the United States in 2001 to 2007

“…In institutions that have lower rates of infection with C. glabrata or in patients for whom infection due to fluconazole-resistant C. glabrata is less likely, fluconazole may still be appropriate as initial therapy for patients who are not critically ill and do not have prior fluconazole exposure (56)(57)(58)80). In such settings, however, it is important to pay strict attention to the appropriate utilization of fluconazole (10,18,29,41,59,90).…”

“…Inappropriate antifungal therapy can occur due to omission of antifungal treatment, incorrect antifungal dosages, or administration of an antifungal agent to which the infecting organism was resistant (21,29,40,41,59,85,90). Previous Infectious Diseases Society of America (IDSA) guidelines recommend that, if fluconazole is used in the treatment of a C. glabrata BSI, a dose of 12 mg/kg of body weight/day (usually Ն800 mg/day) should be administered, while a dose of 6 mg/ kg/day (usually 400 mg/day) is sufficient for Candida albicans, C. parapsilosis, and Candida tropicalis (57,58).…”

“…The exception to this statement is Candida glabrata, of which more than 10% of BSI isolates may be highly resistant (MIC Ն 64 g/ml) to fluconazole (6, 9, 15, 23, 30, 32, 36, 63-65, 71, 87, 91). Suboptimal fluconazole dosing practices (low dose [Ͻ400 mg/day] and poor indications) may lead to an increased frequency of isolation of C. glabrata as an etiological agent of candidemia in hospitalized patients (6,17,29,32,35,41,47,55,60,68,85) and to increased fluconazole (and other azole) resistance secondary to induction of CDR efflux pumps (2,11,13,16,43,47,50,55,69,77,83,84) and may adversely affect the survival of treated patients (7,10,29,40,59,90). Among the various Candida species, C. glabrata alone has increased as a cause of BSI in U.S. intensive care units since 1993 (89).…”

“…It has been shown that the prevalence of C. glabrata as a cause of BSI is potentially related to many disparate factors in addition to fluconazole exposure, including geographic characteristics (3, 6, 63-65, 71, 88), patient age (5,6,25,35,41,42,48,63,82,92), and other characteristics of the patient population studied (1, 32, 35, 51). Because C. glabrata is relatively resistant to fluconazole, the frequency with which it causes BSI has important implications for therapy (21,29,32,40,41,45,56,57,59,80,81,86,90).Previously, we examined the susceptibilities to fluconazole of 559 BSI isolates of C. glabrata and grouped the isolates by patient age and geographic location within the United States over the time period from 1992 to 2001 (63). In the present study we build upon this experience and report the fluconazole susceptibilities of 642 BSI isolates of C. glabrata collected from sentinel surveillance sites throughout the United States for the time period from 2001 through 2007 and stratify the results by geographic region and patient age.…”

Triazole Use in the Nursery: Fluconazole, Voriconazole, Posaconazole, and Ravuconazole

“…Unfortunately, with widespread use has come emerging resistance and an alteration of the epidemiology of candidiasis in adult populations [29,[37][38][39][40][41][42][43][44][45][46][47]; Candida glabrata is now the most commonly isolated Candida spp from adult patients with IC [16,31,34,[48][49][50][51], and some nurseries have reported Candida glabrata as a predominant fungal pathogen [52].…”