Reduction of fluconazole susceptibility of Candida albicans in APECED patients due to long-term use of ketoconazole and miconazole

We have analysed further the y of usage of antifungals in autoimmune polyendocrinopathy - candidiasis - ectodermal dystrophy (APECED) patients and its impact on the susceptibility to fluconazole in Candida albicans. Data were obtained from patient records up to 30 y earlier. Analysing the use of azoles preceding isolation of each isolate showed that significantly more y of azole usage preceded isolation of C. albicans with decreased susceptibility to fluconazole than isolation of susceptible isolates. This was found to be mainly due to the usage of azoles other than fluconazole. Significantly more y of usage of ketoconazole and miconazole preceded the isolation of strains with decreased susceptibility to fluconazole than susceptible isolates (p=0.0241 and 0.0012, respectively). These results highlight that also topical compounds, in particular miconazole, may influence fluconazole susceptibility. Our data indicate that discretion should be used in the long-term use of all azoles, including topical miconazole. At the same time topical amphotericin B appears to be a safe choice as resistance is very rare despite y of usage.