High susceptibility to fluconazole despite eight years of prophylaxis and therapeutic use in HIV-positive children

N. Kulkova*, J. Sokolova, A. Liskova, J. Vujcikova, A. Kalavska, G. Benca, A. Shahum, V. Sladeckova, M. Kolibab, V. Krcmery

Abstract: 

Introduction: Fluconazole (FLU) has been used for oropharyngeal candidiasis (OPC) as treatment or prevention of OPC relapses in HIV positive patients since 1990. The aim of this study was to determine, whether prolonged use of FLU in prophylaxis or therapy in HIV positive children is not associated with increasing resistance to FLU and or other azoles. Methods: HIV positive children treated with HAART in St. Maximilian Kolbe children clinics (House of Hope, House of family and House of Smile SEUC HIV programme for orphan children) (n=137) have been screened every 6 month for respiratory isolates of yeast to assess the impact of FLU and other antimicrobials on colonization, aetiology and resistance. Nasal and pharyngeal swabs were obtained and samples were transferred in Amies agar by air within 48 hours of collection from Phnom Penh to Vienna/Bratislava/Nitra. Organisms were tested with CLSI approved method in the Reference laboratory of antibiotic resistance, Nitra, Slovakia. Results: Of 137 children, 60,6% female (median age 7, IQR=5-9), received FLU for treatment OPC or prophylaxis 11 ±13 (2-42) months. Totally, 296 isolates were isolated and tested within period 2004 - 2011. Proportion of Candida albicans cases was 72,3% and non-albicans cases increased from 15,5% in 2005 to 37,5% in 2011. Non-candida species decreased from 15,5% (2005) to 0% (2011). Commonest non-albicans species was Candida tropicalis (5,7%), Candida parapsilosis (5,4%), Candida krusei (3,4%) and commonest non-candida was Aspergillus niger (3,7%). Previous treatment with fluconazole or other azoles was not associated with increased resistance in Candida species. Susceptibility to fluconazole was 89%, itraconazole 90% and voriconazole 98% and did not change during study period. Conclusion: Frequent azole consumption in children with AIDS on HAART may not be automatically related with non-albicans Candida species shift in aetiology and/or azole resistance, as seen from 8 years follow up on aetiology and resistance to antifungals in Candida and other pathogenic fungi causing opportunistic infection in AIDS children. The reconstitution of the immune system is probably protective factor against colonization and infection of the respiratory system by resistant mutants.
2013

abstract No: 

R2864

Full conference title: 

23rd European Congress of Clinical Microbiology and Infectious Diseases