Prospective, Multicenter Surveillance Study of Candida glabrata : Fluconazole and Itraconazole Susceptibility Profiles in Bloodstream, Invasive, and Colonizing Strains and Differences between Isolates from Three Urban Teaching Hospitals in New York City ( Candida Susceptibility Trends Study, 1998 to 1999)

Abstract

Since the 1990s, the substantial increase in the rate of Candida glabrata infections has become a serious problem. As most C. glabrata infections arise from the host's endogenous microflora, the present prospective, multicenter analysis included all clinical isolates associated with colonization and with systemic and hematogenous candidiasis. Among 347 C. glabrata isolates, the overall rates of resistance to fluconazole (MIC > 64 g/ ml) and itraconazole (MIC > 1 g/ml) were 10.7 and 15.2%, respectively, although for half (n ‫؍‬ 148) of the itraconazole-susceptible isolates the MICs (0.25 to 0.5 g/ml) were in the susceptible-dependent upon dose range. Fluconazole resistance was more common among C. glabrata isolates obtained from centers caring for patients with cancer (MICs at which 90% of isolates are inhibited [MIC 90 s] ‫؍‬ 32 g/ml) or AIDS (MIC 90 s > 64 g/ml) than among C. glabrata isolates from a community-based university medical center (MIC 90 s ‫؍‬ 16 g/ ml) (P ‫؍‬ 0.001). Thirty-three bloodstream isolates and those obtained from other body sites had similar in vitro susceptibility profiles. The fluconazole MIC 90 s (<16 g/ml) for C. glabrata yeast isolates from the gastrointestinal tract were lower than those (>64 g/ml) for C. glabrata isolates from respiratory and urinary tract samples (P ‫؍‬ 0.01). A similar discrepancy for itraconazole was not significant (P > 0.5). We did not observe differences in fluconazole or itraconazole susceptibility profiles among C. glabrata isolates associated with either hematogenous dissemination or colonization. The significant discrepancy in antifungal susceptibility among C. glabrata organisms isolated from hospitals in the same geographic region emphasizes the significance of periodic susceptibility surveillance programs for individual institutions, especially those providing care to patients at risk.

Geographic Variation in the Susceptibilities of Invasive Isolates of Candida glabrata to Seven Systemically Active Antifungal Agents: a Global Assessment from the ARTEMIS Antifungal Surveillance Program Conducted in 2001 and 2002

“…has increased as a cause of BSI in U.S. intensive care units. Other studies have shown that in certain regions of the United States, C. glabrata both is a common cause of BSI and is also often resistant to fluconazole (26,30,35,42). The U.S. findings, however, may not be universal (15,24,27).…”

“…There is no question that C. glabrata has emerged as an important, and potentially resistant, opportunistic fungal pathogen (9,10,26,30,35,40). Trick et al (40) have demonstrated that C. glabrata alone among Candida spp.…”

Variation in Susceptibility of Bloodstream Isolates of Candida glabrata to Fluconazole According to Patient Age and Geographic Location

“…Although much has been written regarding the importance of fluconazole resistance among clinical isolates of C. glabrata (3,7,12,18,(22)(23)(24)26), we found that resistance to fluconazole among bloodstream isolates of C. glabrata was much lower than 10% in seven of the nine U.S. census regions and in four of the six patient age groups ( Table 2). Aside from the MidAtlantic and South Atlantic regions (regions 8 and 9, respectively), resistance was negligible among C. glabrata bloodstream isolates from pediatric patients and from individuals Ͼ65 years of age.…”

Susceptibility of Candida spp. clinical isolates to antimycotics and disinfectants

“…In a large prospective surveillance study Safdar et al [7] noticed that 15.2% and 10.7% of C. glabrata isolates were resistant to itraconazole and fluconazole, respectively. In our study only 5/49 of C. albicans isolates turned out to be resistant to itraconazole, but approximately half of the C. glabrata isolates, were resistant to itraconazole and fluconazole.…”

“…strains isolated from different clinical materials to antifungal agents have been published widely [5][6][7][8][9][10][11][12][13]. However, data concerning the susceptibility of clinical yeast isolates both to antifungal drugs and fungicidal agents used for disinfection and antisepsis procedures are limited.…”