Increase in Candida krusei infection among patients with bone marrow transplantation and neutropenia treated prophylactically with fluconazole

John R. Wingard, William G. Merz, Michael G. Rinaldi, Thomas R. Johnson, Judith E. Karp, Judith Karp

Research output: Contribution to journalArticle

Abstract

Background. In early 1990 fluconazole was introduced as a prophylactic antifungal agent after bone marrow transplantation. During the same year Candida krusei emerged as the chief candida pathogen among patients with bone marrow transplants. Methods. To determine whether there was a correlation between the introduction of fluconazole and the increased incidence of C. krusei, we conducted a retrospective study based on the medical, mycologic, and autopsy records of all adult inpatients who had undergone bone marrow transplantation (n = 296) or who had leukemia (n = 167) at the study center during 1989 and 1990. Results. The 84 patients who received antifungal prophylaxis with fluconazole had a sevenfold greater frequency of C. krusei infection than the 335 patients who did not receive fluconazole (8.3 percent vs. 1.2 percent, P = 0.002), despite having a lower frequency of disseminated C. albicans and C. tropicalis infections (0 vs. 6.0 percent, P = 0.02). Ten of the 11 C. krusei infections were controlled by a combination of amphotericin B and flucytosine. Colonization by C. krusei was found in 40.5 percent of the patients who received fluconazole but in only 16.7 percent of those who did not receive it (P

Original languageEnglish (US)
Pages (from-to)1274-1277
Number of pages4
JournalNew England Journal of Medicine
Volume325
Issue number18
StatePublished - Oct 31 1991
Externally publishedYes

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Fluconazole
Neutropenia
Bone Marrow Transplantation
Candida
Infection
Flucytosine
Antifungal Agents
Amphotericin B
Inpatients
Autopsy
Leukemia
Retrospective Studies
Bone Marrow
Transplants
Incidence

ASJC Scopus subject areas

  • Medicine(all)

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Increase in Candida krusei infection among patients with bone marrow transplantation and neutropenia treated prophylactically with fluconazole. / Wingard, John R.; Merz, William G.; Rinaldi, Michael G.; Johnson, Thomas R.; Karp, Judith E.; Karp, Judith.

In: New England Journal of Medicine, Vol. 325, No. 18, 31.10.1991, p. 1274-1277.

Research output: Contribution to journalArticle

Wingard, John R. ; Merz, William G. ; Rinaldi, Michael G. ; Johnson, Thomas R. ; Karp, Judith E. ; Karp, Judith. / Increase in Candida krusei infection among patients with bone marrow transplantation and neutropenia treated prophylactically with fluconazole. In: New England Journal of Medicine. 1991 ; Vol. 325, No. 18. pp. 1274-1277.
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