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

DOI: 10.1128/JCM.40.10.3551-3557.2002

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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.
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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.

TABLE 1.

Surveillance programs for candidemia^a

Type	Surveillance program	Reference(s)
Population-based surveillance	Centers for Disease Control
	San Francisco and Atlanta, 1992-1993	21
	Baltimore and Connecticut, 1998-2000	—^b
Sentinel surveillance and nosocomial infection surveillance	National Epidemiology of Mycoses Study	4, 39, 49, 56
Sentinel surveillance and nosocomial infection surveillance	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

TABLE 2.

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

Surveillance program^a	Years	Reference(s)	No. of isolates reported	% of total
Surveillance program^a	Years	Reference(s)	No. of isolates reported	C. albicans	C. glabrata	C. parapsilopsis	C. tropicalis	C. krusei	Candida spp.
CDC	1992-1993	21	837	52	12	21	10	4	1
NEMIS	1993-1995	48	79	56	15	15	10	0	4
SCOPE	1995-1998	12, 40	934	53	20	10	12	3	2
CDC	1998-2000	—^b	944	45	24	13	12	2	4
EIEIO	1998-2001	11	254	58	20	7	11	2	2
SENTRY	1997-2000	46	2,047	54	16	15	10	2	3

↵ 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 population	Surveillance program^a	Yrs	References	% of total
Study population	Surveillance program^a	Yrs	References	C. albicans	C. glabrata	C. parapsilopsis	C. tropicalis	C. krusei	Candida spp.
Adults	NEMIS	1993-1995	4, 48	48	24	5	19	0	0
	NNIS	1989-1999	—^d	59	12	10	11	NA^c	NA
	CDC	1998-2000	—^b	48	25	12	14	NA	NA
	SENTRY	1997-2000	46	50	23	12	10	2	NA
Neonates	CDC	1992-1993	21	53	0	45	0	0	2
	NEMIS	1993-1995	48, 56	63	6	29	0	0	3
	NNIS	1989-1999	—^d	54	2	38	4	0	2
	SENTRY	1997-2000	46	60	3	24	7	0	6

TABLE 4.

Fluconazole resistance among Candida BSI isolates as determined by different surveillance programs^a

Surveillance program	Yrs	References	No. of BSI tested	% Resistant to fluconazole^b
Surveillance program	Yrs	References	No. of BSI tested	C. albicans	C. glabrata	C. parapsilopsis	C. tropicalis
CDC	1992-1993	21	394	1	14	0	2
CDC	1998-2000	—^c	944	1	10	0	6
Sweden	1994-1998	7	233	0	40	15	0
Quebec	1996-1998	60	442	1	9	0	0
SENTRY	1997-2000	46	2,047	1	7	0	1
EIEIO	1998-2001	11	254	0	10	0	0

↵ 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 triazoles^a

Antifungal agent	Suscep- tibility category^b	No. of isolates	Cumulative % inhibited at MIC (μg/ml):
Antifungal agent	Suscep- tibility category^b	No. of isolates	0.12	0.25	0.5	1	2	4	8
Voriconazole	RR	37	0	2.7	10.8	18.9	37.8	40.5	40.5
	RS	38	2.6	26.3	55.3	94.7	100
Ravuconazole	RR	32	12.5	18.8	25.0	40.6	43.8	46.9	46.9
	RS	38	50.0	89.5	97.4	100

↵ 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.