Emergence of Nonalbicans Candida Species in Immunocompromised Leukemia Patients during Fluconazole Treatment.

The incidence of the emergence of nonalbicans Candida species during fluconazole treatment was surveyed in leukemia patients who were severely immunocompromised due to either intensive chemotherapy or bone marrow transplantation during the 3-year period from April 1993 to March 1996. Thirty-three patients received either prophylactic or therapeutic fluconazole administration for at least 7 days. In 7 of these 33 patients (21.2%), nonalbicans Candida including C. krusei, C. glabrata, C. maris, and C. inconspicua emerged during, or immediately after, fluconazole administration, with C. inconspicua the most prevalent Candida spp. Since these yeast strains are resistant to fluconazole, it is possible that selection occurred favoring Candida spp. resistant to fluconazole. Therefore, surveillance for yeast strains resistant to fluconazole should be performed as a routine procedure during fluconazole administration. In cases of resistance, other effective antifungal agents should be administered.