# Opportunistic Fungi in Cancer and Hematopoietic Stem-Cell Transplant Patients: Diagnosis and Management Strategies
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Therapeutic Strategies: Prevention of Fungal Infections
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Resistance Concerns

A major concern about use of antifungal drugs for prophylaxis centers on the emergence of organisms resistant to these agents. In contrast to HIV-infected patients who frequently receive azole prophylaxis for many months and experience a relatively high incidence of infection by azole-resistant fungi, HSCT recipients and other oncology patients who have received prophylactic fluconazole have a low incidence of infection caused by fluconazole-resistant fungi. In a study at the Fred Hutchinson Cancer Research Center, 256 (44%) of 588 patients were colonized with Candida species while receiving prophylactic fluconazole following HSCT performed between January 1994 and June 1997.20 However, only 4.6% of the patients developed candidemia (most commonly with C glabrata, C parapsilosis, and C krusei). C krusei and C glabrata are usually resistant to fluconazole and have also been the cause of occasional breakthrough infections at other HSCT centers using prophylactic fluconazole.92,93

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Therapeutic Strategies: Prevention of Fungal Infections
   Environmental Issues
   Choice of Antifungal Agent
   Resistance Concerns
   Enhancing Host Defenses

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Course Number: V035D

This CME Expires on July 1, 2005; no tests will be accepted after this date.

This course is accredited by The University of Pittsburgh School of Medicine, Center for Continuing Education and The International Immunocompromised Host Society

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