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Journal of Clinical Microbiology, December 2005, p. 5848-5859, Vol. 43, No. 12
0095-1137/05/$08.00+0     doi:10.1128/JCM.43.12.5848-5859.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.

Results from the ARTEMIS DISK Global Antifungal Surveillance Study: a 6.5-Year Analysis of Susceptibilities of Candida and Other Yeast Species to Fluconazole and Voriconazole by Standardized Disk Diffusion Testing

University of Iowa College of Medicine, Iowa City, Iowa,¹ University of Texas Health Science Center, San Antonio, Texas,² University of Wales College of Medicine, Cardiff, United Kingdom,³ Zhong Shan Hospital, Shanghai, China,⁴ Institute of Antimicrobial Chemotherapy, Smolensk, Russia,⁵ Hospital de Clinicas "Jose de San Martin," Buenos Aires, Argentina ,⁶ Institute of Clinical Microbiology, Faculty of Medicine, University of Szeged, Szeged, Hungary,⁷ Giles Scientific, Inc., Santa Barbara, California⁸

Received 12 July 2005/ Returned for modification 17 August 2005/ Accepted 12 September 2005

Fluconazole in vitro susceptibility test results for 140,767 yeasts were collected from 127 participating investigators in 39 countries from June 1997 through December 2003. Data were collected on 79,343 yeast isolates tested with voriconazole from 2001 through 2003. All investigators tested clinical yeast isolates by the CLSI (formerly NCCLS) M44-A disk diffusion method. 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."

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