In the past few years, we have detected in the United Kingdom and in the United States several isolates of Candida glabrata that grew poorly unless bile was available. Cholesterol, a component of bile, stimulated equivalent growth of the bile-dependent isolates. The bile-dependent C. glabrata isolates appeared resistant to amphotericin B, but their resistance to fluconazole was unclear. These results demonstrate that occasional isolates of C. glabrata require cholesterol to grow, they may not be detected in specimens set up on standard primary plating media, and they may be difficult to eradicate in patients with antifungal agents directed against ergosterol and its synthetic pathway.
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