Test plates were automatically read and results were recorded with the BIOMIC Vision Image Analysis System. Species, drug, zone diameter, susceptibility category, and quality control results were collected quarterly via e-mail for analysis. Duplicate (the same patient, same species, and same susceptible-resistant biotype profile during any 7-day period) and uncontrolled test results were not analyzed. The 10 most common species of yeasts all showed less resistance to voriconazole than to fluconazole. Candida krusei showed the largest difference, with over 70% resistance to fluconazole and less than 8% to voriconazole. All species of yeasts tested were more susceptible to voriconazole than to fluconazole, assuming proposed interpretive breakpoints of >17 mm (susceptible) and <13 mm (resistant) for voriconazole. MICs reported in this study were determined from the zone diameter in millimeters from the continuous agar gradient around each disk, which was calibrated with MICs determined from the standard CLSI M27-A2 broth dilution method by balanced-weight regression analysis. The results from this investigation demonstrate the broad spectrum of the azoles for most of the opportunistic yeast pathogens but also highlight several areas where resistance may be progressing and/or where previously rare species may be "emerging."

Candida krusei is well known as a fungal pathogen for patients with hematologic malignancies and for transplant recipients. Using the ARTEMIS Antifungal Surveillance Program database, we describe geographic and temporal trends in the isolation of C. krusei from clinical specimens and the in vitro susceptibilities of 3,448 isolates to voriconazole as determined by CLSI (formerly NCCLS) disk diffusion testing. In addition, we report the in vitro susceptibilities of bloodstream infection isolates of C. krusei to amphotericin B (304 isolates), flucytosine (254 isolates), anidulafungin (121 isolates), caspofungin (300 isolates), and micafungin (102 isolates) as determined by CLSI broth microdilution methods. Geographic differences in isolation were apparent; the highest frequency of isolation was seen for the Czech Republic (7.6%) and the lowest for Indonesia, South Korea, and Thailand (0 to 0.3%). Overall, 83% of isolates were susceptible to voriconazole, ranging from 74.8% in Latin America to 92.3% in North America. C. krusei was most commonly isolated from hematology-oncology services, where only 76.7% of isolates were susceptible to voriconazole. There was no evidence of increasing resistance of C. krusei to voriconazole from 2001 to 2005. Decreased susceptibilities to amphotericin B (MIC at which 90% of isolates were inhibited [MIC 90 ], 4 g/ml) and flucytosine (MIC 90 , 16 g/ml) were noted, whereas 100% of isolates were inhibited by <2 g/ml of anidulafungin (MIC 90 , 0.06 g/ml), micafungin (MIC 90 , 0.12 g/ml) or caspofungin (MIC 90 , 0.25 g/ml). C. krusei is an uncommon but multidrugresistant fungal pathogen. Among the systemically active antifungal agents, the echinocandins appear to be the most active against this important pathogen.

Invasive fungal infections continue to show steady growth among various patient populations, accompanied by high rates of both morbidity and attributive mortality. For the treatment of invasive mycoses, a few number of drugs are currently available, which include polyenes, azoles, echinocandins, allylamines and flucytosine. Among these groups, echinocandins – anidulafungin, caspofungin and mycafungin – represent a key class of antifungal drugs, primarily for the treatment of the most common form of systemic fungal infections – Invasive candidiasis. Possessing a unique mechanism of action that determines fungicidal activity against yeast pathogens, a predictable pharmacokinetics profile, and good safety profile, echinocandins have firmly taken the lead in the treatment of infections caused by Candida species. In addition, they are used in the treatment of refractory cases of invasive aspergillosis and for the prevention of invasive mycoses in selected patient populations. In this brief review, the main clinical and pharmacological characteristics of echinocandins and their positioning within the current versions of practical recommendations will be presented.

Objective. To determine susceptibility of C. glabrata isolates to anidulafungin, caspofungin and micafungin using the SensititreTM YeastOneTM system. Materials and Methods. C. glabrata isolates were taken prospectively from clinical specimens or from strains collections in the participating sites. Susceptibility determination was performed using SensititreTM YeastOneTM (YO10 panel) according to the manufacturer’s guidance, and results were interpreted with M27-A3 CLSI guidelines. Susceptibility of C. glabrata to fluconazole was also determined in order to assess possible correlations of echinocandins and fluconazole minimal inhibitory concentrations (MICs) in resistant strains. Results. A total of 59 C. glabrata strains were tested. The strains were isolated mostly from peripheral blood (44%). Among clinically significant medical conditions/risk factors and co-morbidities, central venous catheter, solid tumors, and abdominal surgery were identified in 20 (33.9%), 19 (32.2%), and 14 (23.7%) patients, respectively. Most MIC values of echinocandins were 0.015 and 0.03 mg/L. Caspofungin has slightly higher MIC values than those of anidulafungin and micafungin. No isolates were resistant to any of the echinocandins. The only 2 patients were receiving echinocandin therapy at the time of taking biosamples (with no reported information about treatment efficacy); those strains were also susceptible to all echinocandins. All C. glabrata strains were susceptible dose-dependent to fluconazole with MIC values between 2 and 32 mg/L. Conclusions. All of the echinocandins have a high and comparable in vitro activity against C. glabrata, including strains which are susceptible dose-depended to fluconazole. More prospective studies are needed to investigate the long-term trends in susceptibility profiles of pathogens causing candidiasis, especially C. glabrata.

An update on 2010 clinical practice guideline on Clostridium difficile infection (CDI) by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) was published in March 2018. This new version of guideline not only includes significant changes in the management of this infection and reflects the evolving controversy over best methods for diagnosis and threatment of CDI but has also incorporated recommendations for children. This document currently is the most complete and up to date source of information on CDI. In the present article we reviewed this new IDSA/SHEA guideline and compared it with existing European and Russian guidelines.