Candida guilliermondii, an Opportunistic Fungal Pathogen with Decreased Susceptibility to Fluconazole: Geographic and Temporal Trends from the ARTEMIS DISK Antifungal Surveillance Program

DOI: 10.1128/JCM.00865-06

Article Figures & Data

TABLE 1.

Variation in frequency of Candida guilliermondii by geographic region^a

Region	Total no. of Candida species isolates	Total no. (%) of C. guilliermondii isolates
Asia-Pacific	17,183	190 (1.1)
Europe	41,187	392 (1.0)
Latin America	11,280	413 (3.7)
North America	6,111	34 (0.6)
Total	75,761	1,029 (1.4)

↵a Data were obtained from the ARTEMIS DISK Global Antifungal Surveillance Program, 2001 to 2003. Isolates represent all incident isolates from all sites of infection.

TABLE 2.

Geographic variation in susceptibility of Candida guilliermondii to fluconazole and voriconazole

Region	Antifungal agent	No. of isolates tested	% of isolates^a
Region	Antifungal agent	No. of isolates tested	S	SDD	R
Asia-Pacific	Fluconazole	190	77.4	14.7	7.9
	Voriconazole	105	87.6	2.9	9.5
Europe	Fluconazole	392	73.0	14.0	13.0
	Voriconazole	220	92.8	3.6	3.6
Latin America	Fluconazole	413	77.0	12.8	10.2
	Voriconazole	274	91.6	4.0	4.4
North America	Fluconazole	34	67.7	23.5	8.8
	Voriconazole	34	88.2	8.8	3.0
Total	Fluconazole	1,029	75.2	14.0	10.8
	Voriconazole	633	91.2	3.9	4.9

↵a All isolates were tested by the disk diffusion method performed in accordance with CLSI standard M44-A. S, susceptible, with zone diameters of ≥19 mm for fluconazole and ≥17 mm for voriconazole; SDD, susceptible-dose dependent, with zone diameters of 15 to 18 mm for fluconazole and 14 to 16 mm for voriconazole; R, resistant, with zone diameters of ≤14 mm for fluconazole and ≤13 mm for voriconazole.

TABLE 3.

Susceptibility of Candida guilliermondii to fluconazole and voriconazole by clinical service

Clinical service (total no. of isolates)^a	Antifungal agent	No. of isolates tested (%)^b	% of isolates from service^c	% of isolates
Clinical service (total no. of isolates)^a	Antifungal agent	No. of isolates tested (%)^b	% of isolates from service^c	S	SDD	R
Hematology-oncology (4,635)	Fluconazole	47 (4.6)	1.0	78.7	6.4	14.9
	Voriconazole	32 (5.1)		96.9		3.1
Medical (17,408)	Fluconazole	159 (15.4)	0.9	79.9	13.2	6.9
	Voriconazole	124 (19.6)		93.5	3.2	3.2
Surgical (5,126)	Fluconazole	51 (5.0)	0.9	68.6	23.5	7.8
	Voriconazole	47 (7.4)		91.5	4.3	4.3
Intensive care unit (10,052)	Fluconazole	67 (6.5)	0.7	79.1	11.9	9.0
	Voriconazole	55 (8.7)		90.9	1.8	7.3
Dermatology (1,457)	Fluconazole	158 (15.3)	10.8	57.6	24.1	18.4
	Voriconazole	121 (19.1)		90.9	6.6	2.5
Urology (649)	Fluconazole	14 (1.4)	2.2	78.6	7.1	14.3
	Voriconazole	6 (0.9)		83.3	16.7
Outpatient (6,414)	Fluconazole	47 (4.6)	0.7	74.5	10.6	14.9
	Voriconazole	25 (3.9)		84.0	8.0	8.0
Other, NOS (30,020)	Fluconazole	486 (47.2)	1.6	79.2	11.5	9.3
	Voriconazole	223 (35.2)		90.1	3.2	6.7

↵a Total number of Candida isolates from each service.
↵b Percentage of all C. guilliermondii isolates tested.
↵c C. guilliermondii as a percentage of all isolates from that clinical service.

TABLE 4.

Susceptibility of Candida guilliermondii to fluconazole and voriconazole by specimen type

Specimen type/site (total no. of isolates)^a	Antifungal agent	No. of isolates tested (%)^b	% of isolates from site^c	% of isolates
Specimen type/site (total no. of isolates)^a	Antifungal agent	No. of isolates tested (%)^b	% of isolates from site^c	S	SDD	R
Blood (8,256)	Fluconazole	307 (29.8)	3.7	85.0	9.1	5.9
	Voriconazole	198 (31.3)		93.4	1.5	5.1
NSBF (3,155)	Fluconazole	36 (3.5)	1.1	72.2	22.2	5.6
	Voriconazole	30 (4.7)		96.7	3.3
Urine (9,722)	Fluconazole	78 (7.6)	0.8	71.8	12.8	15.4
	Voriconazole	51 (8.1)		80.4	3.9	15.7
Respiratory (20,274)	Fluconazole	136 (13.2)	0.7	77.2	10.3	12.5
	Voriconazole	72 (11.3)		88.8	4.2	7.0
Skin/soft tissue (4,986)	Fluconazole	127 (12.3)	2.5	67.7	24.4	7.9
	Voriconazole	103 (16.3)		93.4	5.8	1.0
Genital (15,831)	Fluconazole	44 (4.3)	0.3	84.1	6.8	9.1
	Voriconazole	20 (3.2)		95.0	5.0
Misc., NOS (13,537)	Fluconazole	301 (29.3)	2.2	67.4	16.6	16.0
	Voriconazole	159 (25.1)		89.9	5.7	4.4