caa a22 4500 397593228 CHVBK 20180308164944.0 cr unu---uuuuu 161202e199610 xx s 000 0 eng 10.1093/jac/38.4.691 doi (NATIONALLICENCE)oxford-10.1093/jac/38.4.691 Analysis of the risk factors associated with the emergence of azole resistant oral candidosis in the course of HIV infection [Elektronische Daten] [Mario Tumbarello, Germana Caldarola, Evelina Tacconelli, Giulia Morace, Brunella Posteraro, Roberto Cauda, Luigi Ortona] The objective of this case-control study, conducted in a large Italian university hospital over a 12-month period, was to evaluate the risk factors associated with the emergence of azole resistant oral candidosis in 64 Human Immunodeficiency Virus (HIV) infected patients. A swab was obtained from each patient by brushing candidal lesions. Candida albicans was isolated in 41 patients (64%), Candida glabrata in ten (16%), Candida krusei in five (8%), Candida kefyr in two (3%), Candida tropicalis in two (3%), and Candida lipolytica and Candida guilliermondii in one case, respectively. Two patients suffered a double infection i.e. C. albicans + C. krusei and C. albicans + C. glabrata, respectively. Candida species were tested in vitro for their susceptibility to ketoconazole, fiuconazole, itraconazole and amphotericin B. MICs of the four antifungal drugs were obtained for each yeast using a microdilution broth method developed in our laboratory. Twenty four (37%) of the isolated strains were resistant both to itraconazole and fluconazole, five (8%) to fiuconazole alone, and two (3%) to ketoconazole alone, while none of the isolated strains was resistant to amphotericin B. Patients with oral candidosis caused by a strain resistant to one or more azole drug were compared to control patients with azole-susceptible oral candidosis. On univariate analysis, more than five episodes of oral candidosis in the last year (P = 0.01), previous use of azole therapy (P = 0.001), C2-3 category of HIV infection (P = 0.01) and low number of circulating CD4+ T-cells (P = 0.03) were significantly associated with an increased risk for the development of azole resistance. However, previous use of azole therapy was the only factor selected by a stepwise logistic regression analysis which was independently associated with the isolation of azole resistant strains (P = 0.003). Our findings indicate that, in view of the potential risk for the emergence and selection of azole resistant strains of Candida in patients with AIDS, it is important to carefully choose the antifungal drug for the therapy of mild fungal infections after evaluation of the in-vitro susceptibility of the isolated strains. © 1995 The British Society for Antimicrobial Chemotherapy Original articles nationallicence Tumbarello Mario Department of Infectious Diseases, Catholic University, Rome, Italy, Rome, Italy aut Caldarola Germana Department of Infectious Diseases, Catholic University Rome, Italy aut Tacconelli Evelina Department of Infectious Diseases, Catholic University Rome, Italy aut Morace Giulia Department of Microbiology, Catholic University Rome, Italy aut Posteraro Brunella Department of Microbiology, Catholic University Rome, Italy aut Cauda Roberto Department of Infectious Diseases, Catholic University Rome, Italy aut Ortona Luigi Department of Infectious Diseases, Catholic University Rome, Italy aut Journal of Antimicrobial Chemotherapy Oxford University Press 38/4(1996-10), 691-699 0305-7453 38:4<691 1996 38 jac https://doi.org/10.1093/jac/38.4.691 text/html Onlinezugriff via DOI 1 other jats NATIONALLICENCE 856 40 https://doi.org/10.1093/jac/38.4.691 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Tumbarello Mario Department of Infectious Diseases, Catholic University, Rome, Italy, Rome, Italy aut NATIONALLICENCE 700 1- Caldarola Germana Department of Infectious Diseases, Catholic University Rome, Italy aut NATIONALLICENCE 700 1- Tacconelli Evelina Department of Infectious Diseases, Catholic University Rome, Italy aut NATIONALLICENCE 700 1- Morace Giulia Department of Microbiology, Catholic University Rome, Italy aut NATIONALLICENCE 700 1- Posteraro Brunella Department of Microbiology, Catholic University Rome, Italy aut NATIONALLICENCE 700 1- Cauda Roberto Department of Infectious Diseases, Catholic University Rome, Italy aut NATIONALLICENCE 700 1- Ortona Luigi Department of Infectious Diseases, Catholic University Rome, Italy aut NATIONALLICENCE 773 0- Journal of Antimicrobial Chemotherapy Oxford University Press 38/4(1996-10), 691-699 0305-7453 38:4<691 1996 38 jac Metadata rights reserved CC BY-NC-4.0 http://creativecommons.org/licenses/by-nc/4.0 nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-oxford