Affiliation:
1. Departments of Internal Medicine
2. Pathology, University of Iowa Carver College of Medicine
3. Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa 52242
Abstract
ABSTRACT
Five
Candida
species (
C. albicans
,
C. glabrata
,
C. tropicalis
,
C. parapsilosis
, and
C. krusei
) account for over 95% of invasive candidiasis cases. Some less common
Candida
species have emerged as causes of nosocomial candidiasis, but there is little information about their in vitro susceptibilities to antifungals. We determined the in vitro activities of fluconazole, voriconazole, posaconazole, amphotericin B, anidulafungin, caspofungin, and micafungin against invasive, unique patient isolates of
Candida
collected from 100 centers worldwide between January 2001 and December 2007. Antifungal susceptibility testing was performed by the CLSI M27-A3 method. CLSI breakpoints for susceptibility were used for fluconazole, voriconazole, anidulafungin, caspofungin, and micafungin, while a provisional susceptibility breakpoint of ≤1 μg/ml was used for amphotericin and posaconazole. Of 14,007
Candida
isolates tested, 658 (4.7%) were among the less common species. Against all 658 isolates combined, the activity of each agent, expressed as the MIC
50
/MIC
90
ratio (and the percentage of susceptible isolates) was as follows: fluconazole, 1/4 (94.8%); voriconazole, 0.03/0.12 (98.6%); posaconazole, 0.12/0.5 (95.9%); amphotericin, 0.5/2 (88.3%); anidulafungin, 0.5/2 (97.4%); caspofungin, 0.12/0.5 (98.0%); and micafungin, 0.25/1 (99.2%). Among the isolates not susceptible to one or more of the echinocandins, most (68%) were
C. guilliermondii
. All isolates of the less common species within the
C. parapsilosis
complex (
C. orthopsilosis
and
C. metapsilosis
) were susceptible to voriconazole, posaconazole, anidulafungin, caspofungin, and micafungin. Over 95% of clinical isolates of the rare
Candida
species were susceptible to the available antifungals. However, activity did vary by drug-species combination, with some species (e.g.,
C. rugosa
and
C. guilliermondii
) demonstrating reduced susceptibilities to commonly used agents such as fluconazole and echinocandins.
Publisher
American Society for Microbiology
Cited by
103 articles.
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