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Journal of Clinical Microbiology, September 2001, p. 3254-3259, Vol. 39, No. 9
0095-1137/01/$04.00+0 DOI: 10.1128/JCM.39.9.3254-3259.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.
International Surveillance of Bloodstream Infections Due to
Candida Species: Frequency of Occurrence and In Vitro
Susceptibilities to Fluconazole, Ravuconazole, and Voriconazole of
Isolates Collected from 1997 through 1999 in the SENTRY
Antimicrobial Surveillance Program
M. A.
Pfaller,1,*
D. J.
Diekema,1,2
R. N.
Jones,1,
H. S.
Sader,3
A. C.
Fluit,4
R. J.
Hollis,1
S. A.
Messer,1 and
The SENTRY
Participant Group
Departments of
Pathology1 and
Medicine,2 University of Iowa
College of Medicine, Iowa City, Iowa; Universidade Federal de Sao
Paulo/EPM Sao Paulo, Brazil3; and
University Hospital Utrecht, Utrecht, The
Netherlands4
Received 20 November 2000/Returned for modification 19 April
2001/Accepted 29 May 2001
A surveillance program (SENTRY) of bloodstream infections (BSI) in
the United States, Canada, Latin America, and Europe from 1997 through
1999 detected 1,184 episodes of candidemia in 71 medical centers (32 in
the United States, 23 in Europe, 9 in Latin America, and 7 in Canada).
Overall, 55% of the yeast BSIs were due to Candida
albicans, followed by Candida glabrata and
Candida parapsilosis (15%), Candida tropicalis
(9%), and miscellaneous Candida spp. (6%). In the United
States, 45% of candidemias were due to non-C. albicans
species. C. glabrata (21%) was the most common
non-C. albicans species in the United States, and the
proportion of non-C. albicans BSIs was highest in
Latin America (55%). C. albicans accounted for 60% of BSI
in Canada and 58% in Europe. C. parapsilosis
was the most common non-C. albicans species in Latin
America (25%), Canada (16%), and Europe (17%). Isolates of
C. albicans, C. parapsilosis, and C. tropicalis
were all highly susceptible to fluconazole (97 to 100% at
8
µg/ml). Likewise, 97 to 100% of these species were inhibited by
1
µg/ml of ravuconazole (concentration at which 50% were
inhibited [MIC50], 0.007 to 0.03 µg/ml) or
voriconazole (MIC50, 0.007 to 0.06 µg/ml). Both ravuconazole and voriconazole were significantly more
active than fluconazole against C. glabrata
(MIC90s of 0.5 to 1.0 µg/ml versus 16 to 32 µg/ml,
respectively). A trend of increased
susceptibility of C. glabrata to fluconazole was noted
over the three-year period. The percentage of C. glabrata
isolates susceptible to fluconazole increased from 48% in
1997 to 84% in 1999, and MIC50s decreased from 16 to 4 µg/ml. A similar trend was documented in both the Americas (57 to
84% susceptible) and Europe (22 to 80% susceptible). Some
geographic differences in susceptibility to triazole were observed with
Canadian isolates generally more susceptible than isolates from
the United States and Europe. These observations suggest
susceptibility patterns and trends among yeast isolates from BSI and
raise additional questions that can be answered only by
continued surveillance and clinical investigations of the type reported
here (SENTRY Program).
*
Corresponding author. Mailing address: Medical
Microbiology Division, C606 GH, Department of Pathology, University of
Iowa College of Medicine, Iowa City, IA 52242. Phone: (319) 384-9566. Fax: (319) 356-4916. E-mail: michael-pfaller{at}uiowa.edu.

Present address: Beaver Kreek Centre, Suite A, North Liberty, IA
52317.
Journal of Clinical Microbiology, September 2001, p. 3254-3259, Vol. 39, No. 9
0095-1137/01/$04.00+0 DOI: 10.1128/JCM.39.9.3254-3259.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.
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