Community-Acquired Fungemia Due to a Multiple-Azole-Resistant Strain of Candida tropicalis

Candida tropicalis is one of the more common causes of candidemia [1]. Recent reports describing clinical and in vitro resistance of Candida species associated with azole therapy have been of concern [2–4]. Azole-resistant Candida isolates have been identified, particularly in patients with advanced HIV disease. Resistance to fluconazole is infrequently described with regard to immunocompetent individuals [5]. Despite the increase in frequency of isolation, persistent candidemia due to azole-resistant C. tropicalis has not been previously reported. We report a patient from the community with C. tropicalis fungemia who remained candidemic despite high-dose fluconazole therapy. A 46-year-old man with diabetes mellitus was admitted after being found unresponsive. His history included use of alcohol, injection drugs, and cigarettes. On admission he was unresponsive, with a blood pressure of 70 mm Hg over palpable, a pulse rate of 50/min, an oral temperature of 37.3°C, and a respiratory rate of 30 breaths/min. The remainder of his physical examination yielded nothing remarkable.