M. Bülent ERTUĞRUL, Berna GÜLTEKİN, Güliz UYAR, Serkan ÖNCÜ, Serhan SAKARYA

Amfoterisin-B'ye dirençli C.krusei'de kaspofungin kullanımı çözüm olabilir mi? Olgu eşliğinde tartışma

Ağız tabanında gelişen karsinom nedeniyle 2 kür kemoterapi alan ve sonrasında febril nötropenik atak nedeniyle geniş spektrumlu antibakteriyel kullanan ve ardından amfoterisin-B'ye dirençli Candida krusei'ye bağlı kandida özofajiti oluşan olgu literatür bilgileri eşliğinde tartışılmıştır.

Anahtar Kelimeler:

Amfoterisin B, Tedavi sonucu, Candida, İlaç direnci, fungal

Can caspofungin be a solution for amphotericin-B-resistant C.krusei infections? Presentation of a case

A patient with oral carcinoma was treated with chemotherapy and thereafter febrile neutropenia developed. Following the administration of broad spectrum antibiotics, the patient suffered from esophagitis caused by Candida krusei which was detected resistant to amfotericin-B. The patient was successfully treated with caspofungin.

Keywords:

Amphotericin B, Treatment Outcome, Candida, Drug Resistance, Fungal,

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1. Arathoon EG, Gotuzzo E, Noriega LM, Berman RS, DinubileMJ, Sable CA: Randomized, double-blind, multicenter study of caspofungin versus amphotericinBfor treatment of oropharyngeal and esophageal candidiases, Antimicrob Agents Chemother 2002;46(2):451-7.
2. Maenza JR, Merz WG, Romagnoli MJ, Keruly JC, Moore RD, Gallant JE: Infection due to fluconazole-resistant Candida in patients withAIDS: prevalence and microbiology, Clin Infect Dis 1997;24(1):28-34.
3. MartinsMD, Lozano-ChiuM, Rex JH: Point prevalence of oropharyngeal carriage of fluconazole-resistant Candida in human immunodeficiency virus-infected patients, Clin Infect Dis 1997;25(4):843-6.
4. Masia Canuto M, Gutierrez Rodero F: Antifungal drug resistance to azoles and polyenes, Lancet Infect Dis 2002;2(9):550-63.
5. Mora-Duarte J, Betts R, Rotstein C et al: Comparison of caspofungin and amphotericin B for invasive candidiasis, N Engl J Med 2002;347 (25):2020-9.
6. National Committe for Clinical Laboratory Standards: ReferenceMethod for Broth DilutionAntifungal Susceptibility Testing ofYeasts;Approved Standard, National Committe for Clinical Laboratory Standards,Wayne, PA (1997).
7. National Committe for Clinical Laboratory Standards: ReferenceMethod for Broth DilutionAntifungal Susceptibility Testing ofYeasts;Approved Standard, National Committe for Clinical Laboratory Standards,Wayne, PA (2002).
8. Nolte FS, Parkinson T, Falconer DJ et al: Isolation and characterization of fluconazole- and amphotericin B-resistant Candida albicans from blood of two patients with leukemia, Antimicrob Agents Chemother 1997;41(1):196-9.
9. Powderly WG, Kobayashi GS, Herzig GP, Medoff G: Amphotericin B-resistant yeast infection in severely immunocompromised patients, Am J Med 1988;84(5):826-32.
10. Rex JH,Walsh TJ, Sobel JD et al: Practice guidelines for the treatment of candidiasis, Infectious Diseases Society of America, Clin Infect Dis 2000;30(4):662-78.
11. Sanglard D,Odds FC: Resistance of Candida species to antifungal agents: molecular mechanisms and clinical consequences, Lancet Infect Dis 2002;2(2):73-85.
12. Stone EA, Fung HB, Kirschenbaum HL: Caspofungin: an echinocandin antifungal agent, Clin Ther 2002;24(3):351-77; discussion 29.
13. Vanden Bossche H, Marichal P, Odds FC: Molecular mechanisms of drug resistance in fungi, Trends Microbiol 1994;2(10):393-400.
14. VillanuevaA,Arathoon EG, Gotuzzo E, Berman RS, Dinubile MJ, Sable CA:Arandomized double-blind study of caspofungin versus amphotericin for the treatment of candidal esophagitis, Clin Infect Dis 2001;33(9): 1529-35.
15. White TC, Marr KA, Bowden RA: Clinical, cellular, and molecular factors that contribute to antifungal drug resistance, Clin Microbiol Rev 1998;11(2):382-402.