Results from the ARTEMIS DISK Global Antifungal Surveillance Study, 1997 to 2007: 10.5-Year Analysis of Susceptibilities of Noncandidal Yeast Species to Fluconazole and Voriconazole Determined by CLSI Standardized Disk Diffusion Testing

Abstract

Fluconazole in vitro susceptibility test results determined by the CLSI M44-A disk diffusion method for 11,240 isolates of noncandidal yeasts were collected from 134 study sites in 40 countries from June 1997 through December 2007. Data were collected for 8,717 yeast isolates tested with voriconazole from 2001 through 2007. A total of 22 different species/organism groups were isolated, of which Cryptococcus neoformans was the most common (31.2% of all isolates). Overall, Cryptococcus (32.9%), Saccharomyces (11.7%), Trichosporon (10.6%), and Rhodotorula (4.1%) were the most commonly identified genera. The overall percentages of isolates in each category (susceptible, susceptible dose dependent, and resistant) were 78.0%, 9.5%, and 12.5% and 92.7%, 2.3%, and 5.0% for fluconazole and voriconazole, respectively. Less than 30% of fluconazoleresistant isolates of Cryptococcus spp., Cryptococcus albidus, Cryptococcus laurentii, Trichosporon beigelii/Trichosporon cutaneum, Rhodotorula spp., Rhodotorula rubra/Rhodotorula mucilaginosa, and Rhodotorula glutinis remained susceptible to voriconazole. Emerging resistance to fluconazole was documented among isolates of C. neoformans from the Asia-Pacific, Africa/Middle East, and Latin American regions but not among isolates from Europe or North America. This survey documents the continuing broad spectrum of activity of voriconazole against opportunistic yeast pathogens but identifies several of the less common species with decreased azole susceptibility. These organisms may pose a future threat to optimal antifungal therapy and emphasize the importance of prompt and accurate species identification.Although the majority of infections caused by yeasts are due to Candida (46,54,55,57), there are other yeast genera that may be considered to be "true pathogens" (i.e., Cryptococcus neoformans) or opportunists (e.g., Saccharomyces, Trichosporon, and Rhodotorula) that have taken advantage of immunocompromising conditions, indwelling devices, and broadspectrum antimicrobial use to colonize and infect at-risk patients (6, 7, 20, 26, 33, 39, 46, 55-57, 61, 62). Life-threatening infections caused by these less common fungi pose difficult management issues (1,7,55,61,62).Our knowledge of the epidemiology and antifungal susceptibilities of both Candida and C. neoformans has been enhanced through national, regional, and global surveillance (4,7,8,10,26,27,40,54,56,57,66); however, the same cannot be said for the other opportunistic yeast pathogens (46,55). Among the few surveillance programs that have monitored infection and resistance associated with noncandidal yeasts (15,21,(56)(57)(58), only the ARTEMIS Global Antifungal Surveillance Program has tracked this disparate group of organisms in a program that is both longitudinal and global in scope (29,51,56).The ARTEMIS program employs standardized Clinical Laboratory Standards Institute (CLSI) methods used for "routine" testing of fluconazole and voriconazole in participating laboratories (disk diffusion), uses electronic data capture and ...

Diagnosis of invasive fungal infections by a real-time panfungal PCR assay in immunocompromised pediatric patients

“…Whenever possible, specimens were collected at first onset of fever, within 48 h thereafter, and at subsequent time points in the course of the febrile episode, upon availability. On average, four peripheral blood samples were investigated during each episode (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]. In selected instances, depending on availability, additional types of specimens derived from primarily sterile sites of suspected infection were collected and subjected to molecular analysis.…”

“…The vast majority of IFD events are still caused by Candida and Aspergillus species; however, changes in the epidemiology have occurred over the past decades. [1][2][3][4][5] Recent studies from North American and European centers indicate an increasing incidence of previously uncommon fungal genera, such as Cryptococcus, Trichosporon, Malassezia, 6,7 Fusarium, 8,9 Scedosporium, Pseudallescheria, 10,11 and, very importantly, different members of the class Zygomycetes, such as Rhizopus and Mucor. 12 Timely detection of the fungal pathogens is a prerequisite for successful therapy and the clinical outcome in patients with IFD.…”

Comparação entre microdiluição e disco difusão para o teste de susceptibilidade aos antifúngicos contra Candida spp.

“…Pfaller et al, comparando as mesmas metodologias para o fluconazol contra 3.227 cepas de todas as partes do mundo, incluindo o Brasil, encontro um percentual de concordância por volta de 90% (PFALLER et al, 2009a).…”

“…No entanto, a resistência à anfotericina B não é comumente detectada, apesar dessa droga está em uso a mais de 50 anos (DIEKEMA et al, 2009;LANIADO-LABORÍN;CABRALES-VARGAS, 2009). Na última década foram implantados programas de vigilância da resistência fúngica, o mais importante deles é o ARTEMIS DISK, que monitora a resistência ao fluconazol e ao voriconazol em 134 instituições de 40 países, incluindo o Brasil, utilizando a metodologia de disco difusão (PFALLER et al, 2008(PFALLER et al, , 2009a(PFALLER et al, , 2009b(PFALLER et al, , 2010b.…”

Case Report of Cryptococcus Albidus Peritonitis in a Peritoneal Dialysis Patient and a Review of the Literature

“…In our patient, treatment with that agent was successful. It is important to note that C. albidus also exhibits susceptibility to flucytosine, posaconazole, fluconazole, voriconazole, itraconazole, and miconazole in some cases (10,11,13,19,(27)(28)(29). Because of these variations in C. albidus antifungal susceptibility, treatment should ideally be tailored to the individual disease-causing organism.…”