High prevalence of non-albicans yeasts and detection of anti-fungal resistance in the oral flora of patients with advanced cancer

Palliat Med. 2003 Sep;17(6):477-81. doi: 10.1191/0269216303pm793oa.


Oral fungal infections frequently develop in individuals with advanced cancer. This study examined the oral mycological flora of 207 patients receiving palliative care for advanced malignant disease. Demographic details and a clinical history were documented from each participant. A tongue swab was collected and cultured on CHROMAgar Candida (CHROMAgar Paris, France). All yeasts were identified by germ tube test, API ID 32C profiles and, for Candida dubliniensis, by species-specific PCR. Susceptibility to fluconazole and itraconazole was determined by a broth microdilution assay according to the National Committee for Clinical Laboratory Standards (NCCLS). At time of sampling, 54 (26%) of the 207 subjects had clinical evidence of a fungal infection and yeasts were isolated from 139 (67%) individuals. In total, 194 yeasts were isolated, of which 95 (49%) were Candida albicans. There was a high prevalence of Candidia glabrata (47 isolates) of which 34 (72%) were resistant to both fluconazole and itraconazole. All nine isolates of C. dubliniensis recovered were susceptible to both azoles. No relationship was established between anti-fungal usage in the preceding three months and the presence of azole resistant yeasts. This study of patients with advanced cancer has demonstrated a high incidence of oral colonization with non-C. albicans yeasts, many of which had reduced susceptibility to fluconazole and itraconazole. The role of improved oral care regimes and novel anti-fungal drugs merits further attention, to reduce the occurrence of fungal infection in these patients.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antifungal Agents / therapeutic use
  • Drug Resistance, Fungal
  • Female
  • Fluconazole / therapeutic use
  • Humans
  • Itraconazole / therapeutic use
  • Male
  • Middle Aged
  • Mouth / microbiology
  • Mouth Diseases / drug therapy*
  • Mouth Diseases / microbiology
  • Mycoses / drug therapy*
  • Mycoses / microbiology
  • Neoplasms / complications
  • Neoplasms / microbiology*
  • Opportunistic Infections / complications
  • Opportunistic Infections / microbiology*
  • Palliative Care
  • Yeasts / drug effects
  • Yeasts / isolation & purification*


  • Antifungal Agents
  • Itraconazole
  • Fluconazole