TY - JOUR
T1 - Amphotericin B-resistant yeast infection in severely immunocompromised patients
AU - Powderly, William G.
AU - Kobayashi, George S.
AU - Herzig, Geoffrey P.
AU - Medoff, Gerald
N1 - Funding Information:
From the Divisions of Infectious Diseases, Laboratory Medicine, and Hematology, Washington University School of Medicine, St. Louis, Missouri. This work was supported in part by Grant Al-16228 from the Program in Medical Mycology and Training Grants AI-07 172 and AI-070 15 from the National Institute of Allergy and Infectious Diseases. This study was presented in part at the annual meeting of the American Federation for Clinical Research, May 2, 1986, in Washington, D.C. Requests for reprints should be addressed to Dr. William G. Powderly, Division of Infectious Diseases, Department of Medicine, Box 8051, Washington University School of Medicine, 660 South Euclid, St. Louis, Missouri 63110. Manuscript submitted October 8, 1987, and accepted in revised form February 29, 1988.
PY - 1988/5
Y1 - 1988/5
N2 - Systemic yeast infections are a major cause of morbidity and mortality in severely immunocompromised patients. The in vitro susceptibility to amphotericin B of 29 yeasts causing fungemia was examined in 26 patients undergoing allogeneic or autologous bone marrow transplantation and/or myelosuppressive chemotherapy. The minimal inhibitory concentrations (MICs) of amphotericin B observed with blood isolates from these patients were significantly higher than those observed with blood, sputum, or skin isolates from non-immunocompromised patients (p <0.01). All episodes (10 of 10) of bloodstream infection in immunocompromised patients caused by isolates with MICs greater than 0.8 μg/ml were fatal, versus eight of 17 episodes of bloodstream infection caused by yeasts with MICs of 0.8 μg/ml or less (p = 0.04). Although 15 of 26 patients received empiric treatment with amphotericin B before laboratory evidence of fungemia developed, the amphotericin B susceptibilities of their isolates were not significantly different from those of patients who had not received empiric amphotericin B treatment. It is concluded that yeast fungemia in severely immunocompromised patients is often caused by organisms resistant to the usual concentrations of amphotericin B obtainable in vivo, and that this finding is clinically significant.
AB - Systemic yeast infections are a major cause of morbidity and mortality in severely immunocompromised patients. The in vitro susceptibility to amphotericin B of 29 yeasts causing fungemia was examined in 26 patients undergoing allogeneic or autologous bone marrow transplantation and/or myelosuppressive chemotherapy. The minimal inhibitory concentrations (MICs) of amphotericin B observed with blood isolates from these patients were significantly higher than those observed with blood, sputum, or skin isolates from non-immunocompromised patients (p <0.01). All episodes (10 of 10) of bloodstream infection in immunocompromised patients caused by isolates with MICs greater than 0.8 μg/ml were fatal, versus eight of 17 episodes of bloodstream infection caused by yeasts with MICs of 0.8 μg/ml or less (p = 0.04). Although 15 of 26 patients received empiric treatment with amphotericin B before laboratory evidence of fungemia developed, the amphotericin B susceptibilities of their isolates were not significantly different from those of patients who had not received empiric amphotericin B treatment. It is concluded that yeast fungemia in severely immunocompromised patients is often caused by organisms resistant to the usual concentrations of amphotericin B obtainable in vivo, and that this finding is clinically significant.
UR - http://www.scopus.com/inward/record.url?scp=0023936247&partnerID=8YFLogxK
U2 - 10.1016/0002-9343(88)90059-9
DO - 10.1016/0002-9343(88)90059-9
M3 - Article
C2 - 3284339
AN - SCOPUS:0023936247
SN - 0002-9343
VL - 84
SP - 826
EP - 832
JO - The American journal of medicine
JF - The American journal of medicine
IS - 5
ER -