Article Figures & Data
Tables
- TABLE 1.
Species distribution of Candida isolates over 10.5 yearsa
Organism Isolates tested by period: 1997-2000 2001-2004 2005-2007 1997-2007 No. % of total No. % of total No. % of total No. % of total Candida albicans 39,152 70.9 71,027 62.9 57,598 65.0 167,777 65.3 C. glabrata 5,634 10.2 12,963 11.5 10,342 11.7 28,939 11.3 C. tropicalis 2,996 5.4 8,496 7.5 7,050 8.0 18,542 7.2 C. parapsilosis 2,633 4.8 7,783 6.9 5,005 5.6 15,421 6.0 C. krusei 1,207 2.2 2,840 2.5 2,239 2.5 6,286 2.4 C. guilliermondii 367 0.7 902 0.8 508 0.6 1,777 0.7 C. lusitaniae 276 0.5 674 0.6 559 0.6 1,509 0.6 C. kefyr 182 0.3 527 0.5 517 0.6 1,226 0.5 C. inconspicua 9 0.02 276 0.2 290 0.3 575 0.2 C. famata 123 0.2 375 0.3 247 0.3 745 0.3 C. rugosa 35 0.06 469 0.4 134 0.2 638 0.2 C. dubliniensis 1 <0.01 113 0.1 197 0.2 311 0.1 C. norvegensis 11 0.02 135 0.1 113 0.1 259 0.1 C. lipolytica 7 0.01 80 0.07 50 0.06 137 0.05 C. sake 20 0.02 67 0.08 87 0.03 C. pelliculosa 1 <0.01 47 0.04 40 0.05 88 0.03 C. apicola 57 0.06 57 0.02 C. zeylanoides 4 <0.01 50 0.04 20 0.02 74 0.03 C. valida 9 <0.01 12 0.01 21 <0.01 C. intermedia 10 <0.01 14 0.01 24 <0.01 C. pulcherrima 6 <0.01 8 <0.01 14 <0.01 C. haemulonii 6 <0.01 3 <0.01 9 <0.01 C. stellatoidea 7 <0.01 7 <0.01 C. utilis 6 <0.01 6 <0.01 C. humicola 2 <0.01 4 <0.01 6 <0.01 C. lambica 5 <0.01 5 <0.01 C. ciferrii 2 <0.01 2 <0.01 C. colliculosa 2 <0.01 2 <0.01 C. holmii 1 <0.01 1 <0.01 C. marina 1 <0.01 1 <0.01 C. sphaerica 1 <0.01 1 <0.01 Candida spp. NOSb 2,591 4.7 6,186 5.5 3,558 4.0 12,335 4.8 Total 55,229 100.0 112,996 100.0 88,647 100.0 256,882 100.0 - TABLE 2.
Geographic variation in frequency of common and uncommon species of Candida: ARTEMIS, 2001 to 2007a
Species Species distribution (%) by region (total no. of isolates)b: APAC (44,674) EU (109,643) AF/ME (8,259) LAM (27,395) NAM (11,682) Total (201,653) C. albicans 64.4 67.9 67.1 51.8 48.9 63.8 C. glabrata 12.6 11.3 8.8 7.4 21.1 11.6 C. tropicalis 11.7 4.9 6.6 13.2 7.3 7.7 C. parapsilosis 7.4 4.2 6.0 10.3 13.6 6.3 C. krusei 1.2 3.4 1.6 1.4 3.1 2.5 C. guilliermondii 0.4 0.5 0.1 2.2 0.5 0.7 C. inconspicua <0.1 0.5 <0.1 <0.1 0.3 C. rugosa 0.4 <0.1 <0.1 1.2 <0.1 0.3 C. norvegensis <0.1 0.2 <0.1 <0.1 0.2 0.1 - TABLE 3.
In vitro susceptibilities of Candida spp. to fluconazole and voriconazole as determined by CLSI disk diffusion testinga
Species Fluconazoleb Voriconazoleb No. of isolates tested % S % R No. of isolates tested % S % R C. albicans 128,625 98.0 1.4 125,965 98.5 1.2 C. glabrata 23,305 68.7 15.7 22,968 82.9 10.0 C. tropicalis 15,546 91.0 4.1 15,198 89.5 5.4 C. parapsilosis 12,788 93.2 3.6 12,453 97.0 1.8 C. krusei 5,079 8.6 78.3 5,005 83.2 7.6 C. guilliermondii 1,410 73.5 11.4 1,375 90.5 5.7 C. lusitaniae 1,233 92.1 5.4 1,215 96.7 2.0 C. kefyr 1,044 96.5 2.7 1,032 98.7 0.9 C. inconspicua 566 22.6 53.2 563 90.6 3.9 C. famata 622 79.1 10.3 606 90.3 5.0 C. rugosa 603 49.9 41.8 580 69.3 21.2 C. dubliniensis 310 96.1 2.6 308 98.4 1.0 C. norvegensis 248 41.9 40.7 247 91.5 4.0 C. lipolytica 130 66.2 28.5 128 77.3 14.1 C. sake 87 85.1 11.5 87 92.0 6.9 C. pelliculosa 87 89.7 6.9 86 94.2 4.7 C. apicola 57 98.2 1.8 57 98.2 1.8 C. zeylanoides 70 67.1 24.3 67 85.1 6.0 C. valida 21 23.8 61.9 22 81.8 13.6 C. intermedia 24 95.8 4.2 25 100.0 0.0 C. pulcherrima 14 100.0 0.0 14 100.0 0.0 C. haemulonii 9 88.9 11.1 9 88.9 11.1 C. stellatoidea 7 85.7 0.0 7 85.7 14.3 C. utilis 6 83.3 0.0 7 100.0 0.0 C. humicola 6 50.0 50.0 6 50.0 33.3 C. lambica 5 0.0 80.0 5 40.0 20 C. ciferrii 2 50.0 50.0 2 50.0 0.0 C. colliculosa 2 100.0 0.0 2 100.0 0.0 C. holmii 1 100.0 0.0 1 100.0 0.0 C. marina 1 0.0 0.0 1 100.0 0.0 C. sphaerica 1 100.0 0.0 1 100.0 0.0 Candida spp.c 9,744 86.2 8.9 9,577 93.6 4.1 ↵a Isolates were obtained from 133 institutions, 2001 to 2007.
↵b Fluconazole and voriconazole disk diffusion testing was performed in accordance with CLSI document M44-A (7). The interpretive breakpoints (zone diameters) were as follows: S, ≥19 mm (fluconazole) and ≥17 mm (voriconazole); R, ≤14 mm (fluconazole) and ≤13 mm (voriconazole).
↵c Candida species, not otherwise specified.
- TABLE 4.
In vitro susceptibilities of fluconazole-resistant isolates of Candida spp. to voriconazole as determined by CLSI disk diffusion testinga
Species No. of isolates tested % S % SDD % R C. albicans 1,782 28.1 8.4 63.6 C. glabrata 3,550 19.1 21.7 59.2 C. tropicalis 629 17.0 15.3 67.7 C. parapsilosis 431 39.2 20.4 40.4 C. krusei 3,889 79.6 11.3 9.2 C. guilliermondii 157 43.9 16.6 39.5 C. lusitaniae 63 55.6 17.5 27.0 C. kefyr 27 66.7 7.4 25.9 C. inconspicua 297 83.8 10.1 6.1 C. famata 62 37.1 24.2 38.7 C. rugosa 242 28.1 21.5 50.4 C. dubliniensis 8 62.5 0.0 37.5 C. norvegensis 100 81.0 10.0 9.0 C. lipolytica 37 29.7 27.0 43.2 C. sake 9 44.4 11.1 44.4 C. pelliculosa 6 16.7 16.7 66.7 C. apicola 1 0.0 0.0 100.0 C. zeylanoides 15 46.7 26.7 26.7 C. valida 14 71.4 7.1 21.4 C. intermedia 1 100.0 0.0 0.0 C. haemulonii 1 0.0 0.0 100.0 C. humicola 3 0.0 33.3 66.7 C. lambica 4 25.0 50.0 25.0 C. ciferrii 1 0.0 100.0 0.0 Candida spp.b 850 47.6 14.6 37.8 - TABLE 5.
Trends in in vitro resistance to fluconazole among Candida spp. as determined by CLSI disk diffusion testing over a 10.5-year perioda,b
Species 1997-2000 2001-2004 2005-2007 No. of isolates tested % R No. of isolates tested % R No. of isolates tested % R C. albicans 39,152 0.9 71,027 1.4 57,598 1.4 C. glabrata 5,634 19.2 12,963 15.9 10,342 15.4 C. tropicalis 2,996 3.6 8,496 4.5 7,050 3.6 C. parapsilosis 2,633 2.5 7,783 3.5 5,005 3.6 C. krusei 1,207 65.8 2,840 77.5 2,239 79.3 C. guilliermondii 367 12.5 902 9.9 508 14.2 C. lusitaniae 276 2.9 674 4.3 559 6.6 C. kefyr 182 3.3 527 3.6 517 1.7 C. inconspicua 9 55.6 276 52.2 290 54.1 C. famata 123 17.1 375 12.5 247 6.9 C. rugosa 35 34.3 238 50.7 134 10.4 C. dubliniensis 1 0.0 113 2.7 197 2.0 C. norvegensis 11 54.5 135 36.3 113 46.0 C. lipolytica 7 0.0 80 37.5 50 14.0 C. sake 20 10.0 67 11.9 C. pelliculosa 1 0.0 47 0.0 40 15.0 C. apicola 57 1.8 C. zeylanoides 4 0.0 50 28.0 20 15.0 C. valida 9 66.7 12 58.3 C. intermedia 10 0.0 14 7.1 C. pulcherrima 6 0.0 8 0.0 C. haemulonii 6 0.0 3 33.3 C. stellatoidea 7 0.0 C. utilis 6 0.0 C. humicola 2 50.0 4 50.0 C. lambica 5 80.0 C. ciferrii 2 50.0 C. colliculosa 2 0.0 C. holmii 1 0.0 C. marina 1 0.0 C. sphaerica 1 0.0 Candida spp.c 2,591 10.5 6,186 8.2 3,558 10.1 - TABLE 6.
Trends in in vitro resistance to voriconazole among Candida spp. as determined by CLSI disk diffusion testing over a 7-year perioda,b
Species 2001-2004 2005 2006 2007 No. of isolates tested % R No. of isolates tested % R No. of isolates tested % R No. of isolates tested % R C. albicans 68,575 1.2 18,630 1.5 18,965 1.0 19,795 1.0 C. glabrata 12,643 10.3 3,185 9.5 3,413 10.2 3,727 9.4 C. tropicalis 8,171 6.1 2,136 4.5 2,317 3.8 2,574 5.1 C. parapsilosis 7,464 1.8 1,581 1.9 1,724 1.3 1,687 1.8 C. krusei 2,765 7.7 684 7.9 742 6.5 814 8.0 C. guilliermondii 872 4.9 184 6.5 155 9.7 164 5.5 C. lusitaniae 655 1.8 163 3.1 195 0.5 202 3.0 C. kefyr 514 0.8 173 2.9 153 0.0 192 0.0 C. inconspicua 274 5.5 77 2.6 89 2.2 123 2.4 C. famata 359 6.4 87 1.1 72 1.4 88 5.7 C. rugosa 446 26.7 33 3.0 38 0.0 63 4.8 C. dubliniensis 111 0.9 57 0.0 70 1.4 70 1.4 C. norvegensis 134 2.2 36 0.0 47 10.4 29 6.9 C. lipolytica 79 17.7 17 0.0 14 14.3 18 11.1 C. sake 20 0.0 13 7.7 27 11.1 27 7.4 C. pelliculosa 47 0.0 14 14.3 19 5.3 6 16.7 C. apicola 44 2.3 13 0.0 C. zeylanoides 48 8.3 7 0.0 2 0.0 10 0.0 C. valida 9 11.1 7 28.6 1 0.0 5 0.0 C. intermedia 10 0.0 8 0.0 3 0.0 4 0.0 C. pulcherrima 6 0.0 2 0.0 4 0.0 2 0.0 C. haemulonii 6 0.0 2 50.0 1 0.0 C. stellatoidea 7 14.3 C. utilis 1 0.0 2 0.0 4 0.0 C. humicola 2 50.0 2 50.0 2 0.0 C. lambica 2 0.0 3 33.3 C. ciferrii 1 0.0 1 0.0 C. colliculosa 1 0.0 1 0.0 C. holmii 1 0.0 C. marina 1 0.0 C. sphaerica 1 0.0 Candida spp.c 6,022 4.7 1,183 4.9 1,031 2.4 1,341 2.0 - TABLE 7.
Geographic variation in the in vitro susceptibilities of common and uncommon species of Candida to fluconazole and voriconazole, 2001 to 2007a
Species Antifungal agent APAC EU AF/ME LAM NAM No. of isolates % R No. of isolates % R No. of isolates % R No. of isolates % R No. of isolates % R C. albicans Fluconazole 28,781 0.9 74,408 1.3 5,539 0.6 14,178 2.1 5,718 5.1 Voriconazole 27,827 0.8 72,873 1.1 5,502 0.3 13,711 1.7 5,681 3.6 C. glabrata Fluconazole 5,629 13.0 12,439 16.3 728 16.2 2,039 15.1 2,470 19.5 Voriconazole 5,515 8.2 12,288 9.8 705 8.1 2,000 11.3 2,460 14.6 C. tropicalis Fluconazole 5,178 6.5 5,349 2.9 544 2.6 3,625 2.6 850 4.4 Voriconazole 5,062 8.4 5,128 3.9 542 2.4 3,522 3.7 836 5.3 C. parapsilosis Fluconazole 3,294 4.3 4,578 2.6 499 15.0 2,830 2.1 1,587 3.5 Voriconazole 3,120 1.7 4,487 1.1 496 11.1 2,779 0.9 1,517 2.4 C. krusei Fluconazole 532 73.5 3,678 80.8 134 72.4 370 66.8 361 74.0 Voriconazole 516 5.0 3,637 7.7 134 4.5 351 14.0 363 5.5 C. guilliermondii Fluconazole 178 13.5 567 13.8 12 8.3 590 9.0 63 7.9 Voriconazole 175 10.9 558 6.1 12 0.0 567 3.7 63 4.8 C. inconspicua Fluconazole 4 25.0 558 53.0 2 100.0 2 100.0 Voriconazole 4 0.0 555 3.8 2 50.0 2 0.0 C. rugosa Fluconazole 165 32.1 89 10.1 1 0.0 339 55.5 9 22.2 Voriconazole 145 6.9 87 1.1 1 0.0 338 32.8 9 11.1 C. norvegensis Fluconazole 7 14.3 204 49.0 1 0.0 13 0.0 21 0.0 Voriconazole 7 0.0 203 4.9 1 0.0 13 0.0 21 0.0 ↵a For definitions of abbreviations, see Table 2, footnote b.
- TABLE 8.
Susceptibilities of C. krusei, C. inconspicua, and C. norvegensis to fluconazole and voriconazole by clinical servicea
Clinical service (total no. of isolates) Antifungal agent C. krusei C. inconspicua C. norvegensis No. of isolates tested % Rb No. of isolates tested % R No. of isolates tested % R Hematology-oncology (11,930) Fluconazole 757 83.1 113 51.3 24 50.0 Voriconazole 741 9.6 113 5.3 24 4.2 Medical (47,024) Fluconazole 1,128 79.9 101 42.6 68 33.8 Voriconazole 1,106 7.8 101 4.0 68 2.9 Surgical (12,659) Fluconazole 316 78.5 62 61.3 25 28.0 Voriconazole 320 5.6 62 1.6 25 0.0 ICU (27,758) Fluconazole 706 79.0 78 50.0 26 42.3 Voriconazole 692 6.6 76 2.6 26 0.0 Dermatology (3,001) Fluconazole 32 71.9 4 75.0 2 0.0 Voriconazole 31 6.5 4 50.0 2 0.0 Urology (1,954) Fluconazole 40 60.0 4 25.0 6 83.3 Voriconazole 40 7.5 4 0.0 6 16.7 Outpatient (15,810) Fluconazole 212 74.5 17 23.5 23 34.8 Voriconazole 213 10.3 17 5.9 22 0.0 Other NOS (81,517) Fluconazole 1,888 75.9 187 61.5 74 47.3 Voriconazole 1,862 7.0 186 3.2 74 8.1 - TABLE 9.
Susceptibilities of C. krusei, C. inconspicua, and C. norvegensis to fluconazole and voriconazole by specimen typea
Specimen type/site (total no. of isolates) Antifungal agent C. krusei C. inconspicua C. norvegensis No. of isolates tested % Rb No. of isolates tested % R No. of isolates tested % R Blood (20,704) Fluconazole 459 74.5 24 37.5 13 7.7 Voriconazole 459 8.5 24 4.2 13 0.0 NSBF (8,650) Fluconazole 246 80.5 45 51.1 18 55.6 Voriconazole 243 4.5 45 4.4 18 0.0 Urine (25,881) Fluconazole 518 80.1 26 53.8 23 56.5 Voriconazole 516 11.4 26 7.7 23 8.7 Respiratory tract (56,961) Fluconazole 1,787 79.2 231 51.5 64 42.2 Voriconazole 1,760 7.8 229 2.2 63 1.6 Skin/soft tissue (11,221) Fluconazole 252 81.7 23 26.1 23 8.7 Voriconazole 251 8.0 23 4.3 23 0.0 Genital tract (44,839) Fluconazole 566 71.9 62 62.9 19 52.6 Voriconazole 553 6.9 62 4.8 19 0.0 Miscellaneous NOS (33,397) Fluconazole 1,251 79.2 155 58.7 88 43.2 Voriconazole 1,223 5.8 154 5.2 88 8.0