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Selection of Candida glabrata in pediatric bone marrow transplant recipients receiving fluconazole

J E Hoppe1, T Klingebiel, D Niethammer

  • 1Department of Pediatric Hematology and Oncology, University Children's Hospital, Tübingen, Germany.

Pediatric Hematology and Oncology
|March 1, 1994
PubMed

Insights

High rates of Candida glabrata orointestinal colonization were found in pediatric bone marrow transplant patients on fluconazole prophylaxis. This suggests C. glabrata may be selected for due to its low susceptibility to fluconazole.

Area of Science:

  • Medical Mycology
  • Infectious Diseases
  • Hematology

Background:

  • Bone marrow transplantation (BMT) is a critical treatment for various hematologic malignancies and other conditions.
  • Prophylaxis against fungal infections, particularly with azoles like fluconazole, is standard care in BMT recipients.
  • Candida glabrata is an emerging fungal pathogen with intrinsic resistance to azole antifungals.

Observation:

  • A significant proportion (31.3%) of pediatric BMT recipients exhibited orointestinal colonization with Candida glabrata.
  • Colonization was frequently observed in high fungal loads.
  • This occurred despite the patients receiving fluconazole for antifungal prophylaxis.

Findings:

  • The observed high rate of Candida glabrata colonization suggests a selection pressure favoring this species.
  • The intrinsic low susceptibility of C. glabrata to fluconazole is the likely mechanism driving this selection.
  • Fluconazole prophylaxis may inadvertently promote colonization by intrinsically resistant fungal species.

Implications:

  • Clinicians should consider the potential for fluconazole to select for C. glabrata colonization in BMT patients.
  • Alternative or adjunctive antifungal strategies may be needed for high-risk BMT populations.
  • Further research into the epidemiology and clinical impact of C. glabrata in immunocompromised hosts is warranted.

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