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Prevalence of Resistance at Diagnosis, 1994

Douglas A. Jabs, MD; J. P. Dunn, MD; Cheryl Enger, PhD; Michael Forman, MS; Neil Bressler, MD; Patricia Charache, MD; Cytomegalovirus Retinitis and Viral Resistance Study Group

Arch Ophthalmol. 1996;114(7):809-814.

Abstract
Objective
To determine the prevalence of cytomegalovirus (CMV) isolates resistant to ganciclovir sodium or foscarnet sodium at the time of diagnosis of CMV retinitis, prior to the initiation of therapy.

Design
Prospective epidemiologic study. Setting: An acquired immunodeficiency syndrome ophthalmology clinic.

Patients
Patients with acquired immunodeficiency syndrome and newly diagnosed CMV retinitis.

Intervention
Culturing blood and urine samples for CMV and testing of all positive isolates for sensitivity to ganciclovir and foscarnet.

Main Outcome Measure
Prevalence of the following: blood culture isolates resistant to ganciclovir (inhibitory concentration 50% [IC₅₀]>5.5 µmol/L) or foscarnet (IC₅₀>400 µmol/L) and urine culture isolates resistant to ganciclovir or foscarnet.

Results
Forty-nine patients were enrolled during a 13-month period. Forty-four patients had blood culture samples that could be evaluated; of these, 66% were positive (59% of patients). Thirty-four patients had urine cultures that were evaluable; of these, 82% were positive (57% of patients). Overall, 78% of patients had either a urine or blood culture sample positive for CMV. No blood culture isolates were resistant to ganciclovir, and only 1 urine culture isolate (2% of patients) was resistant to ganciclovir. Three percent of blood culture isolates and 4% of urine culture isolates (2% and 2% of patients, respectively) were resistant to foscarnet. Overall, 4% of patients had either a blood or urine culture isolate resistant to foscarnet.

Conclusion
Resistance to ganciclovir or foscarnet at the time of diagnosis of CMV retinitis is uncommon.

Author Affiliations
From the Departments of Ophthalmology (Drs Jabs, Dunn, and Bressler), Oncology (Dr Enger), Pathology (Mr Forman and Dr Charache), and Medicine (Dr Jabs), The Johns Hopkins University School of Medicine, Baltimore, Md. Members of the Cytomegalovirus and Viral Resistance Study Group are listed in a box on page 811.

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