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Role of Sentinel Surveillance of Candidemia: Trends in Species Distribution and Antifungal Susceptibility

M. A. Pfaller, D. J. Diekema
M. A. Pfaller
1Departments of Pathology
2Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa 52242
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  • For correspondence: michael-pfaller@uiowa.edu
D. J. Diekema
1Departments of Pathology
3Medicine, College of Medicine
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DOI: 10.1128/JCM.40.10.3551-3557.2002
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  • FIG. 1.
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    FIG. 1.

    Percentage of all candidemias due to selected Candida species in each age group. Data are from the Emerging Infections and the Epidemiology of Iowa Organisms survey, 1998 to 2001. P = 0.02 for trend of increased frequency of C. glabrata with increasing age. Adapted from reference 11 with permission.

  • FIG. 2.
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    FIG. 2.

    In vitro activity of newer azoles stratified by fluconazole susceptibility. There were 6,268 susceptible (fluconazole MIC, ≤8 μg/ml), 463 susceptible dose-dependent (susc-DD; fluconazole MIC, 16 to 32 μg/ml), and 239 resistant (fluconazole MIC, ≥64 μg/ml) strains. Data are from reference 47.

Tables

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  • TABLE 1.

    Surveillance programs for candidemiaa

    TypeSurveillance programReference(s)
    Population-based surveillanceCenters for Disease Control
        San Francisco and Atlanta, 1992-1993 21
        Baltimore and Connecticut, 1998-2000—b
    Sentinel surveillance and nosocomial infection surveillanceNational Epidemiology of Mycoses Study 4, 39, 49, 56
    Surveillance and Control of Pathogens of Epidemiologic Importance 12, 40
    SENTRY 10, 41-43, 45, 46
    Emerging Infections and the Epidemiology of Iowa Organisms 11
    National Nosocomial Infection Surveillance System 6, 14, 53, 62
    Sweden 7
    Quebec 60
    European Confederation of Medical Mycology 1, 15, 35, 61
    • ↵ a List is not all-inclusive.

    • ↵ b Hajjeh, 6th ASM Conf. Candida and Candidiasis; Lyon et al., 40th ICAAC.

  • TABLE 2.

    Candida species distribution as reported by sentinel and population-based candidemia surveillance programs

    Surveillance programaYearsReference(s)No. of isolates reported% of total
    C. albicansC. glabrataC. parapsilopsisC. tropicalisC. kruseiCandida spp.
    CDC1992-1993 21 8375212211041
    NEMIS1993-1995 48 795615151004
    SCOPE1995-1998 12, 409345320101232
    CDC1998-2000—b9444524131224
    EIEIO1998-2001 11 254582071122
    SENTRY1997-2000 46 2,0475416151023
    • ↵ a CDC, Centers for Disease Control; NEMIS, National Epidemiology of Mycoses Study; SCOPE, Surveillance and Control of Pathogens of Epidemiologic Importance; EIEIO, Emerging Infections and the Epidemiology of Iowa Organisms; NNIS, National Nosocomial Infection Surveillance System.

    • ↵ b Hajjeh, 6th ASM Conf. Candida and Candidiasis; Lyon et al., 40th ICAAC.

  • TABLE 3.

    Candida species distribution in adults and neonates as reported by different candidemia surveillance programs

    Study populationSurveillance programaYrsReferences% of total
    C. albicansC. glabrataC. parapsilopsisC. tropicalisC. kruseiCandida spp.
    AdultsNEMIS1993-1995 4, 48482451900
    NNIS1989-1999—d59121011NAcNA
    CDC1998-2000—b48251214NANA
    SENTRY1997-2000 46 502312102NA
    NeonatesCDC1992-1993 21 53045002
    NEMIS1993-1995 48, 5663629003
    NNIS1989-1999—d54238402
    SENTRY1997-2000 46 60324706
    • ↵ a See Table 2, footnote a, for surveillance program abbreviations.

    • ↵ b See Table 2, footnote b.

    • ↵ c NA, data not available.

    • ↵ d Hajjeh, 6th ASM Conf. Candida and Candidiasis.

  • TABLE 4.

    Fluconazole resistance among Candida BSI isolates as determined by different surveillance programsa

    Surveillance programYrsReferencesNo. of BSI tested% Resistant to fluconazoleb
    C. albicansC. glabrataC. parapsilopsisC. tropicalis
    CDC1992-1993 21 39411402
    CDC1998-2000—c94411006
    Sweden1994-1998 7 233040150
    Quebec1996-1998 60 4421900
    SENTRY1997-2000 46 2,0471701
    EIEIO1998-2001 11 25401000
    • ↵ a See Table 2, footnote a.

    • ↵ b Determined by using NCCLS broth microdilution and interpretive criteria (MIC ≥64 μg/ml) (36).

    • ↵ c Lyon et al., 40th ICAAC.

  • TABLE 5.

    Cross-resistance of C. albicans isolates to licensed and investigational triazolesa

    Antifungal agentSuscep- tibility categorybNo. of isolatesCumulative % inhibited at MIC (μg/ml):
    0.120.250.51248
    VoriconazoleRR3702.710.818.937.840.540.5
    RS382.626.355.394.7100
    RavuconazoleRR3212.518.825.040.643.846.946.9
    RS3850.089.597.4100
    • ↵ a Adapted from reference 47 with permission.

    • ↵ b RR, fluconazole MIC ≥64 μg/ml and itraconazole MIC ≥1 μg/ml; RS, fluconazole MIC ≥64 μg/ml and itraconazole MIC ≤0.12 μg/ml.

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Role of Sentinel Surveillance of Candidemia: Trends in Species Distribution and Antifungal Susceptibility
M. A. Pfaller, D. J. Diekema
Journal of Clinical Microbiology Oct 2002, 40 (10) 3551-3557; DOI: 10.1128/JCM.40.10.3551-3557.2002

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Role of Sentinel Surveillance of Candidemia: Trends in Species Distribution and Antifungal Susceptibility
M. A. Pfaller, D. J. Diekema
Journal of Clinical Microbiology Oct 2002, 40 (10) 3551-3557; DOI: 10.1128/JCM.40.10.3551-3557.2002
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  • Top
  • Article
    • SURVEILLANCE PROGRAMS FOR CANDIDEMIA
    • SPECIES DISTRIBUTION IN CANDIDEMIA
    • ANTIFUNGAL RESISTANCE TRENDS AND NEW DRUG EVALUATION
    • USE OF SURVEILLANCE PROGRAMS IN ASSESSING MECHANISMS OF RESISTANCE
    • DIFFERENT PROGRAMS PROVIDE COMPLEMENTARY DATA
    • SUMMARY AND CONCLUSIONS
    • ACKNOWLEDGMENTS
    • REFERENCES
  • Figures & Data
  • Info & Metrics
  • PDF

KEYWORDS

antifungal agents
Candida
candidiasis
fungemia

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