Risk factors for voriconazole resistance in non/albicans candida in HIV-positive children
Abstract number: 1733_1475
Shahum A., Krcmery V., Liskova A., Kisac P., Hricak V., Karvaj M., Augustinova A., Kalavsky E., Benca J., Seckova S., Holeckova K., Havlikova Z., Sladeckova V., Horvathova D., Havrilova H.
Introduction: Resistance to voriconazole (VOR) has been observed in C. glabrata and mucorales. However in Candida spp. is still rare and represents less than 1% of all Candida spp.
Methods: We have analysed VOR and fluconazole (FLU) resistant candida in HIV-positive children in Cambodia. 8 cases occurred in 2006 after 3 years of HAART among 52 HIV-positive children at antiretroviral therapy (2 C. krusei, 2 C. glabrata, 2 C. famata, 1 C. lusitaniae, 1 C. kefyr).
Results: Non-albicansCandida (NAC) resistant to VOR appeared with no different distribution among children with different degree of immunosuppression. There was unproved significant association with HAART, antituberculotic drug, or pretreatment with antibiotics or antifungals. We did not record any resistance to VOR among C. tropicalis and C. parapsilosis, but resistance to both VOR and FLU were found among C. famata, C. glabrata, C. krusei and C. lusitaniae. VOR-resistant NAC were more likely resistant also to itraconazole and ketokonazole in contrast to FLU-susceptible NAC (P < 0.02 and P < 0.002 respectively). More frequent concomitant resistance to itraconazole, ketokonazole, 5-FC and voriconazole was also seen among FLU-resistant NAC (P < 0.0175, P < 0.004, P < 0.011 and P < 0.02).
Conclusion: VOR-R was related neither to low CD4 count nor to length of HAART or TMP/SMX prophylaxis and also not to antituberculotic and antibiotic therapy. We did not prove any risk factor for VOR resistance among NAC yeasts in HIV-positive children. Resistant NCA to VOR and/or FLU were more likely also resistant to other antifungals.
|Session name:||European Society of Clinical Microbiology and Infectious Diseases|
|Location:||ICC, Munich, Germany|
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