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Journal of Clinical Microbiology, January 2009, p. 117-123, Vol. 47, No. 1
0095-1137/09/$08.00+0     doi:10.1128/JCM.01747-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.

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{triangledown}

M. A. Pfaller,1* D. J. Diekema,1 D. L. Gibbs,2 V. A. Newell,2 H. Bijie,3 D. Dzierzanowska,4 N. N. Klimko,5 V. Letscher-Bru,6 M. Lisalova,7 K. Muehlethaler,8 C. Rennison,9 M. Zaidi,10 the Global Antifungal Surveillance Group

University of Iowa Carver College of Medicine, Iowa City, Iowa,1 Giles Scientific, Inc., Santa Barbara, California,2 Fudan University, Shanghai, China,3 Children's Memorial Health Institute, Warsaw, Poland,4 Kashkin Medical Mycology Research Institute, St. Petersburg, Russia,5 Institut de Parasitologie et de Pathologie Tropicale, Strasbourg, France,6 Mikrobiologicke Laboratorium, Bratislava, Slovakia,7 University of Berne, Berne, Switzerland,8 Royal Victoria Infirmary, Newcastle on Tyne, United Kingdom,9 Hospital General O Horan, Merida, Mexico,10

Received 9 September 2008/ Returned for modification 4 November 2008/ Accepted 5 November 2008

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 fluconazole-resistant 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.

* Corresponding author. Mailing address: Medical Microbiology Division, C606 GH, Department of Pathology, University of Iowa College of Medicine, Iowa City, IA 52242. Phone: (319) 356-8615. Fax: (319) 356-4916. E-mail: michael-pfaller{at}uiowa.edu

{triangledown} Published ahead of print on 12 November 2008.

Journal of Clinical Microbiology, January 2009, p. 117-123, Vol. 47, No. 1
0095-1137/09/$08.00+0     doi:10.1128/JCM.01747-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.



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