Información del artículo
Resumen
Las infecciones por levaduras del género Candida sp. son cada vez más prevalentes en pacientes hospitalizados, especialmente en grupos de mayor riesgo como pueden ser pacientes con neoplasia hematológica bajo tratamiento de quimioterapia y en cuidados intensivos. La resistencia de Candida sp. representa un reto terapéutico que deja un menor número de posibilidades para el tratamiento de estas infecciones que se caracterizan, a su vez, por una alta morbimortalidad. Esta revisión describe los mecanismos de resistencia de Candida sp. a fluconazol y los factores de riesgo para la adquisición de éstos.
Palabras claves:
fluconazol
Candida
Candida albicans
Resistencia a medicamentos
Farmacorresistencia microbiana
Resistencia a múltiples medicamentos
Farmacorresistencia micótica
Abstract
Yeast infections of the genus Candida sp are becoming more prevalent in hospitalized patients, especially in high risk groups such as patients with hematologic malignancy undergoing chemotherapy and in intensive care units. Candida sp's resistance represents a therapeutic challenge that leaves fewer opportunities for the treatment of these infections which are characterized by high morbidity and mortality. This review describes Candida sp's resistance mechanisms to fluconazole and the risk factors for their acquisition.
Key words:
Fluconazole
Candida
Candida albicans
therapeutic use
Drug Resistance
Microbial Drug Resistance
Multiple Drug Resistance
Fungal Drug Resistance
El Texto completo está disponible en PDF
Referencias
[1.]
V. Lorian.
Antibiotics in laboratory medicine.
Antifungal Drugs: Mechanism of Action, Drug resistance, Susceptibility Testing and Assays of activity in biological fluids, 5th, pp. P226-P265
[2.]
Antimicrobial pharmacodynamics in theory and clinical practice, pp. 285-302
[3.]
J.L. Wang, S.C. Chang, P.R. Hsueh, Y.C. Chen.
Species distribution and fluconazole susceptibility of Candida clinical isolates in a medical center in.
J Microbiol immunol infect, 2004 (2002), pp. 236-241
[4.]
C.A. Enwuru, A. Ogunledun, N. Idika, N.V. Enwuru, F. Ogbonna, M. Aniedobe, et al.
Fluconazole resistant opportunistic oro-pharyngeal candida and non-candida yeast-like isolates from HIV infected patients attending ARV clinics in Lagos, Nigeria.
African Health Sciences, 8 (2008), pp. 142-148
[5.]
C. Gutiérrez, C. Bedout, A.M. Tobon, L.E. Cano, M. Arango, A.M. Tabares, et al.
Sensibilidad a fluconazol y voriconazolde aislamientos de Candida spp., obtenidos de mucosa oral de pacientes con sida.
Infectio, 11 (2007), pp. 183-189
[6.]
G.G. Donders, O. Babula, G. Bellen, I.M. Linhares, S.S. Witkin.
Mannosebinding lectin gene polymorphism and resistance to therapy in women with recurrent vulvovaginal candidiasis.
BJOG, 115 (2008), pp. 1225-1231
[7.]
O.C. Alburquerque, D.G. Hermosilla, P.C. Tapia.
Distribución y susceptibilidad a fluconazol de levaduras del género Candida aisladas en pacientes hospitalizados y ambulatorios.
Rev. chil. infectol, 26 (2009), pp. 435-439
[8.]
M. Panizzo, C. Pérez, M.T. Maniscalchi.
Susceptibilidad in vitro a los antifúngicos de Candida sp.. y serotipos de Candida albicans aisladas de pacientes con vaginitis primaria y recurrente.
Rev. Soc. Ven. Microbiol, 20 (2000),
[9.]
V. Silva, J. Diaz, N. Febre.
Red de diagnostico en micologia medica. Vigilancia de la resistencia de levaduras a antifúngicos.
Rev. chil. infectol, 19 (2002), pp. 149-156
[10.]
M.L. Hernaez, Pla Jesús, C. Nombela.
Aspectos moleculares y genéticos de la resistencia a azoles en Candida albicans.
Rev. Iberoam Micol, 14 (1997), pp. 150-154
[11.]
T. White, K. Marr, R. Bowden.
Clinical, cellular, and Molecular factors that contribute to antifungal Drug resistance.
Clinical Microbiology Review, 11 (1998), pp. 382-402
[12.]
M. Martínez, J.L. López-Ribot, W.R. Kirkpatrick, S.P. Bachmann, S. Perea, M.T. Ruesga, et al.
Heterogeneous mechanisms of azole resistance in Candida albicans clinical isolates from an HIV-infected patient on continuous fluconazole therapy for oropharyngeal candidosis.
J Antimicrob Chemother, 49 (2002), pp. 515-524
[13.]
I.A. Casalinuovo, P. Di Francesco, E. Garaci.
Fluconazole resistance in Candida albicans: a review of mechanisms.
Eur Rev Med Pharmacol Sci, 8 (2004), pp. 69-77
[14.]
G.D. Albertson, M. Niimi, R.D. Cannon, H.F. Jenkinson.
Multiple efflux mechanisms are involved in Candida albicans fluconazole resistance.
Antimicrob Agents Chemother, 40 (1996), pp. 2835-2841
[15.]
S. Ferrari, F. Ischer, D. Calabrese, D. Posteraro, M. Sanguinetti, G. Fadda, et al.
Gain of Function Mutations in CgPDR1 of Candida glabrata Not Only Mediate Antifungal Resistance but Also Enhance Virulence.
PLoS Pathogens, 5 (2009), pp. 1-17
[16.]
J. Bille, O. Marchetti, T. Calandra.
Changing face of health care associated fungal infections.
Current Opinion in infectious diseases, 18 (2005), pp. 314-319
[17.]
T.C. Chen, Y.H. Chen, J.J. Tsai, C.F. Peng, P.L. Lu, K. Chang, et al.
Epidemiologic analysis and antifungal susceptibility of Candida blood isolates in southern Taiwan.
Microbiol Inmmunol Infect, 38 (2005), pp. 200-210
[18.]
M.M. Carnuto, F. Gutiérrez Rodero.
Antifungal drug resistance to azoles and polyenes.
The Lancet infectious diseases, 2 (2002), pp. 550-563
[19.]
J.R. Maenza, J.C. Keruly, R.D. Moore, R.E. Chaisson, W.G. Merz, J.E. Gallant.
Risk factors for fluconazole resistant candidiasis in human immunodeficiency virus infected patients.
J infect Dis, 173 (1996), pp. 219-225
[20.]
C.J. Clancy, C.A. Kauffman, A. Morris.
Correlation of fluconazole MIC and response to therapy for patients with candidemia due to C albicans and non C albicans spp: results of a multicenter prospective study of candidemia.
Clin Infect Disease, 27 (1998), pp. 938
[21.]
S.W. Redding, W.R. Kirkpatrick, S. Saville, B.J. Coco, W. White, A. Fothergill.
Multiple patterns of resistance to fluconazole in Candida glabrata isolates from a patient with oropharyngeal candidiasis receiving head and neck radiation.
J Clin Microbiol, 41 (2003), pp. 619-622
[22.]
A Kunova, J Trupl, A. Demitrovicova, Z. Jesenska, S. Grausova, Emicrob. Grey, et al.
Eight-year surveillance of non-albicans Candida spp. in an oncology department prior to and after fluconazole had been introduced into antifungal prophylaxis.
Drug Resist, 3 (1997), pp. 283-287
[23.]
D. Sanglard, F. Ischer, D. Calabrese, P.A. Majcherczyk, J. Bille.
The ATP binding cassette transporter gene CgCDR1 from Candida glabrata is involved in the resistance of clinical isolates to azole antifungal agents.
Antimicrob Agents Chemother, 43 (1999), pp. 2753-2765
[24.]
JW Baddley, M. Patel, M Jones, G. Cloud, AC Smith, S.A. Moser.
Utility of real-time antifungal susceptibility testing for fluconazole in the treatment of candidemia.
Diagn Microbiol Infect Dis, 50 (2004), pp. 119-124
[25.]
S. Takakura, N. Fujihara, T. Saito, T. Kudo, Y. Iinuma, S Ichiyama, et al.
Clinical factors associated with fluconazole resistance and shortterm survival in patients with Candida bloodstream infection.
Eur J Clin Microbiol Infect Dis, 23 (2004), pp. 380-388
[26.]
M. Lin, Y. Carmeli, J. Zumsteg, E. Flores, J. Tolentino, P. Sreeramoju, et al.
Prior Antimicrobial Therapy And Risk For Hospital-Acquired Candida Glabrata And Candida Krusei Fungemia: A Case-Case-Control Study.
Antimicrobial Agents And Chemotherapy, 49 (2005), pp. 4555-4560
[27.]
I. Lee, N. Fishman, T. Zaoutis, K. Morales, M. Weiner, M. Synnestvedt, et al.
Risk Factors for Fluconazole-Resistant Candida glabrata Bloodstream Infections.
Arch Intern Med, 169 (2009), pp. 379-383
[28.]
M.J. Klevay, E.J. Ernst, J.L. Hollanbaugh, J.G. Miller, M.A. Pfaller, D.J. Diekema.
Therapy and outcome of Candida glabrata versus Candida albicans bloodstream infection.
Diagn Microbiol Infect Dis, 60 (2008), pp. 273-277
[29.]
P. Godoy, I.N. Tiraboschi, C. Severo L:, et al.
Species Distirbution and Antifungal Susceptibility Profile of Candida spp Bloodstream isolates from Latin american Hospitals.
Mem Inst Oswaldo Cruz, 98 (2003), pp. 401-405
[30.]
D. Torres, C. Alvarez, M. Rondon.
Fluconazole susceptibility of invasive Candida sp isolates as determined by three methods Bogota - Colombia.
Rev Chil Infect, 26 (2009), pp. 135-143
[31.]
M.A. Pfaller, D.J. Diekema.
Minireview: Role of Sentinel surveillance of Candidemia: Trends in species distribution and antifungal susceptibility.
Journal of Clinical microbiology, 40 (2002), pp. 3551-3557
[32.]
R. Sanchez, P. Rivas, S.I. Cuervo, J. Cortes.
Frecuencia y factores predictores de mortalidad asociados a candidemia em pacientes com câncer (1999-2009).
Infectio, 14 (2010), pp. 39
[33.]
B. Almirante, D. Rodríguez, B.J. Park, M. Cuenca-Estrella, A.M. Planes, M. Almela, et al.
Epidemiology and predictors of Mortality in cases of Candida Bloodstream infection: Results for population Based Surveillance, Barcelona, Spain, from 2002 to 2003.
J Clin Microbiol, 43 (2005), pp. 1829-1835
[34.]
M.A. Pfaller, D.J. Diekema, S.A. Messer, L. Boyken, R.J. Hollis.
Activities of fluconazole and voriconazole against 1,586 recent clinical isolates of Candida species determined by Broth microdilution, disk diffusion, and Etest methods: report from the ARTEMIS Global Antifungal Susceptibility Program, 2001.
J Clin Microbiol, 41 (2003), pp. 1440-1446
[35.]
M.J. Klevay, E.J. Ernst, J.L. Hollanbaugh, J.G. Miller, M.A. Pfaller, D.J. Diekema.
Therapy and outcome of Candida glabrata versus Candida albicans bloodstream infection.
Diagn Microbiol Infect Dis, 60 (2008), pp. 273-277
[36.]
H.M. Kantarjian, S. O’Brien, T.L. Smith, J. Cortes, F.J. Giles, M. Beran, et al.
Results of treatment with hyper-CVAD, a dose-intensive regimen, in adult acute lymphocytic leukemia.
J Clin Oncol, (2000), pp. 547-561
[37.]
A.S. Michalopoulos, S. Geroulanos, S. Mentzelopoulos.
Determinants of candidemia and Candidemia relathed Dead in cardiothoracic ICU patients.
CHEST, 124 (2003), pp. 2244-2255
[38.]
L.P. Brion, S.E. Uko, D.L. Goldman.
Risk of resistance associated with fluconazole prophylaxis: Systematic review.
Journal of Infection, 54 (2007), pp. 521-529
[39.]
J. Garnacho-Montero, A. Díaz-Martín, E. García-Cabrera, M. Ruiz Pérez de Pipaón, C. Hernández-Caballero, J. Aznar-Martín.
Risk factors for fluconazole-resistant candidemia.
Antimicrob Agents Chemother, 54 (2010), pp. 3149-3154
Copyright © 2010. Asociación Colombiana de Infectología (ACIN)
