Background: An increasing frequency of opportunistic fungal infections in immunosuppressed patients in recent years. Concurrent with this finding, it has been noted an increasing use of fluconazole. In addition, non-Candida albicans species (NCAS), most of which are fluconazole-resistant have been increasing isolated. The aim of this study was to investigate the epidemiology of colonization and infection due to NCAS in HIV-infected patients.
Patients and methods: A cross sectional study was conducted with HIV-infected patients in different stages, who were attended at two hospitals in Alicante, Spain. We assessed the prevalence and microbiology of oropharyngeal colonization and infection due to Candida spp., and its fluconazole susceptibility patterns. To determine the clinical risk factors for the development of fluconazole resistance, we carried out a case-control study with prevalent cases.
Results: We studied 168 strains from 153 patients. NCAS were isolated in 32 (21%) of them, 25 (77%) were colonized, and 5 (26%) had infection due to NCAS. The most common isolate was Candida glabrata (n = 15). MICs were significantly higher for NCAS than for Candida albicans species, with a MIC50 of 16 and 0.25 microgram/ml, respectively, and a MIC90 of 128 micrograms/ml and 8 micrograms/ml (p = 0.0001). The median CD4 cell count in patients with NCAS was 0.06 x 10(9)/l, and 0.19 x 10(9)/l patients with Candida albicans (p = 0.009). Overall, 56% of the patients with NCAS and 41% of the patients with Candida albicans had been treated with fluconazole (p = 0.1).
Conclusions: NCAS are isolated in a high proportion of HIV infected patients. Most of the NCAS have a decreased susceptibility to fluconazole. The only risk factor associated with the acquisition of NCAS in HIV-infected patients is an advanced immunosuppression.