Fluconazole-Resistant Candida: Mechanisms and Risk Factor Identification |
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Authors: | MarkAlain D��ry Rodrigo Hasbun |
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Institution: | 2. Infectious Diseases Section, Department of Medicine, Tulane University School of Medicine, 1430 Tulane Ave. SL 87, New Orleans, LA, 70112, USA 1. Division of Infectious Diseases, University of Texas Medical School, 6431 Fannin St. 2.112 MSB, Houston, TX, 77030, USA
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Abstract: | The extensive use of fluconazole in the previous two decades has fostered the emergence of azole-resistant strains, including
non-albicans species such as C. glabrata. The main mechanisms of fluconazole resistance described involve alteration of the quality or quantity of 14-alpha-demethylase
enzyme or reduced access of the drug to the target enzyme by upregulation of efflux pumps. Fluconazole prophylaxis has been
used successfully to prevent fungal infections in high-risk neonates, neutropenic patients, individuals with HIV infection,
recipients of solid organ (eg, liver) transplants and bone marrow transplants, and patients in intensive care units, with
a small increase in the risk of colonization, but not infection, with fluconazole-resistant Candida isolates. Among other risk factors, recent fluconazole exposure is associated with fluconazole-resistant candidemia. |
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