Article Figures & Data
Tables
- Table 1
Geographic distribution of organisms collected during 2010 to 2011 in medical centers participating in the SENTRY Antimicrobial Surveillance Program
Organism/organism group No. of isolates in each indicated geographic region: Total North America Europe Latin America Asia-Pacific Total, yeasts and molds 1,349 1,191 492 384 3,418 Yeast All Candida spp. 1,211 1,097 433 366 3,107 C. albicans 503 552 186 164 1,405 C. glabrata 306 175 38 52 571 C. parapsilosis 173 195 104 93 565 C. tropicalis 109 89 76 44 318 C. krusei 40 28 8 3 79 Other Candida spp.a 80 58 21 10 169 Cryptococcus neoformans 36 9 29 10 84 Other yeastsb 8 21 10 2 41 Mold All Aspergillus spp. 74 51 15 6 146 Aspergillus fumigatus 45 34 13 4 97 Other Aspergillus spp.c 29 16 2 2 49 Other moldsd 20 15 5 40 ↵a Other Candida spp. include C. bracarensis (1 strain), C. catenulata (2 strains), C. dubliniensis (50 strains), C. fabianii (1 strain), C. fermentati (8 strains), C. guilliermondii (19 strains), C. haemulonii (2 strains), C. inconspicua (2 strains), C. kefyr (16 strains), C. lipolytica (4 strains), C. lusitaniae (55 strains), C. nivariensis (2 strains), C. norvegensis (1 strains), C. pararugosa (2 strains), C. pelliculosa (1 strain), and C. intermedia/C. pseudointermedia (3 strains).
↵b Other yeasts include Aureobasidium pullulans (1 strain), Debaryomyces fabryi (1 strain), Dipodascus capitatus (3 strains), Lodderomyces elongisporus (2 strains), Rhodotorula mucilaginosa (5 strains), Saccharomyces cerevisiae (6 strains), Trichosporon asahii (9 strains), Trichosporon mycotoxinivorans (1 strain), Trichosporon spp. (5 strains), and unidentified yeasts (6 strains).
↵c Other Aspergillus spp. include A. alabamensis (2 strains), A. flavus species complex (SC) (19 strains), A. foetidus (1 strain), A. nidulans (2 strains), A. niger SC (15 strains), A. sydowii (2 strains), A. terreus SC (7 strains), and A. ustus SC (1 strain).
↵d Other molds include Absidia (Lichtheimia) corymbifera (1 strain), Acremonium strictum genogroup III (1 strain), Coprinellus radians (1 strain), Fusarium solani SC (3 strains), Gibberella fujikuroi SC (6 strains), Paecilomyces variotii (2 strains), Penicillium roqueforti group (1 strain), Penicillium subgenus Aspergilloides (3 strains), Penicillium subgenus Furcatum (1 strain), Penicillium subgenus Terverticillata (2 strains), Penicillium variabile (1 strain), Phialemonium curvatum (1 strain), Rhizomucor pusillus (1 strain), Rhizopus microsporus group (1 strain), Rhizopus oryzae (1 strain), Sarocladium (Acremonium) kiliense (2 strains), Scedosporium apiospermum (4 strains), Alternaria spp. (2 strains), Curvularia spp. (1 strain), Fusarium spp. (1 strain), Penicillium spp. (1 strain), Trichoderma spp. (1 strain), and Exophiala dermatitidis (1 strain).
- Table 2
Frequency of antifungal resistance among clinical isolates of Candida spp. by geographic region in the 2010-2011 SENTRY Surveillance Program
Candida species Antifungal agent No. of isolates (% resistanta to each antifungal agent) by region North America Europe Latin America Asia-Pacific Total C. albicans Anidulafungin 503 (0.0) 552 (0.0) 186 (0.0) 164 (0.0) 1,405 (0.0) Caspofungin 503 (0.0) 552 (0.4) 186 (0.0) 164 (0.6) 1,405 (0.2) Micafungin 503 (0.0) 552 (0.4) 186 (0.0) 164 (0.0) 1,405 (0.1) Fluconazole 503 (0.6) 552 (0.2) 186 (0.0) 164 (0.6) 1,405 (0.4) Posaconazolec 503 (0.6) 552 (8.3) 186 (6.5) 164 (0.6) 1,405 (4.4) Voriconazole 503 (0.6) 552 (0.2) 186 (0.0) 164 (0.6) 1,405 (0.4) C. glabrata Anidulafungin 306 (1.6) 175 (1.7) 38 (0.0) 52 (3.8) 571 (1.8) Caspofungin 306 (1.6) 175 (1.7) 38 (0.0) 52 (1.9) 571 (1.6) Micafungin 306 (1.3) 175 (1.1) 38 (0.0) 52 (1.9) 571 (1.2) Fluconazole 306 (9.8) 175 (6.3) 38 (5.3) 52 (13.5) 571 (8.8) Posaconazolec 306 (3.3) 175 (2.9) 38 (5.3) 52 (5.8) 571 (3.5) Voriconazoleb 306 (11.1) 175 (9.1) 38 (7.9) 52 (13.5) 571 (10.5) C. parapsilosis Anidulafungin 173 (1.2) 195 (0.0) 104 (1.0) 93 (0.0) 565 (0.5) Caspofungin 173 (0.0) 195 (0.0) 104 (0.0) 93 (0.0) 565 (0.0) Micafungin 173 (0.0) 195 (0.0) 104 (0.0) 93 (0.0) 565 (0.0) Fluconazole 173 (0.0) 195 (3.1) 104 (1.0) 93 (5.4) 565 (2.1) Posaconazolec 173 (1.2) 195 (0.5) 104 (3.9) 93 (6.5) 565 (2.3) Voriconazole 173 (0.0) 195 (0.0) 104 (0.0) 93 (1.1) 565 (0.2) C. tropicalis Anidulafungin 109 (0.0) 89 (0.0) 76 (0.0) 44 (0.0) 318 (0.0) Caspofungin 109 (0.0) 89 (0.0) 76 (0.0) 44 (0.0) 318 (0.0) Micafungin 109 (0.0) 89 (0.0) 76 (0.0) 44 (0.0) 318 (0.0) Fluconazole 109 (2.7) 89 (1.1) 76 (0.0) 44 (0.0) 318 (1.3) Posaconazolec 109 (7.3) 89 (7.9) 76 (2.6) 44 (0.0) 318 (5.3) Voriconazole 109 (0.9) 89 (0.0) 76 (0.0) 44 (0.0) 318 (0.3) C. krusei Anidulafungin 40 (0.0) 28 (0.0) 8 (0.0) 3 (0.0) 79 (0.0) Caspofungin 40 (0.0) 28 (0.0) 8 (0.0) 3 (0.0) 79 (0.0) Micafungin 40 (0.0) 28 (0.0) 8 (0.0) 3 (0.0) 79 (0.0) Posaconazolec 40 (17.5) 28 (7.1) 8 (25.0) 3 (33.3) 79 (15.2) Voriconazole 40 (2.5) 28 (0.0) 8 (0.0) 3 (0.0) 79 (1.3) ↵a Resistance is defined as an MIC of >0.5 μg/ml for anidulafungin, caspofungin, and micafungin against C. albicans, C. tropicalis, and C. krusei, an MIC of >4 μg/ml against C. parapsilosis, an MIC of >0.25 μg/ml for anidulafungin and caspofungin, and an MIC of >0.12 μg/ml for micafungin against C. glabrata; an MIC of >4 μg/ml for fluconazole against C. albicans, C. tropicalis, and C. parapsilosis, an MIC of >32 μg/ml against C. glabrata; and an MIC of >0.5 μg/ml for voriconazole against C. albicans, C. tropicalis, and C. parapsilosis.
↵b In lieu of clinical breakpoints for voriconazole against C. glabrata, the epidemiological cutoff value (ECV) of >0.5 μg/ml was used to identify non-wild-type (non-WT) isolates.
↵c Posaconazole ECVs were used to identify non-WT isolates of C. albicans (ECV > 0.06 μg/ml), C. glabrata (ECV > 2 μg/ml), C. parapsilosis (ECV > 0.25 μg/ml), C. tropicalis (ECV > 0.12 μg/ml), and C. krusei (ECV > 0.5 μg/ml).
- Table 3
Comparison of in vitro susceptibilities of three echinocandins versus isolates of Candida collected during two different time periodsa
Candida species Antifungal agentb Yearsc No. of isolates tested % of isolates at an MIC (μg/ml) of: ≤0.008 0.015 0.03 0.06 0.12 0.25 0.5 1 2 4 ≥8 C. albicans ANF 2003-2007 4,283 7.9 29.8 36.0 20.9 5.0 0.3 <0.1 2010-2011 1,405 9.3 22.6 35.4 24.7 7.0 0.5 0.4 CSF 2003-2007 4,283 2.1 27.6 47.6 21.0 1.6 0.1 2010-2011 1,405 0.7 16.2 45.7 25.9 10.0 0.9 0.4 0.1 0.1 MCF 2003-2007 4,283 14.2 68.9 14.6 2.1 0.1 2010-2011 1,405 4.2 40.2 47.6 6.3 1.1 0.2 0.3 0.1 C. glabrata ANF 2003-2007 1,236 0.6 13.0 57.8 25.9 2.1 0.2 0.2 0.2 0.1 2010-2011 571 0.7 15.2 52.0 25.7 4.6 0.4 1.1 0.2 0.2 CSF 2003-2007 1,236 10.7 59.1 26.6 2.1 0.6 0.6 0.1 0.2 2010-2011 571 1.2 58.5 23.3 13.0 2.5 0.5 0.7 0.2 0.2 MCF 2003-2007 1,236 16.8 75.6 5.7 1.0 0.3 0.2 0.1 0.2 0.1 2010-2011 571 9.8 68.5 17.5 2.1 0.9 0.2 0.7 0.2 0.2 C. parapsilosis ANF 2003-2007 1,238 0.1 0.2 0.1 0.1 1.1 4.0 25.8 61.8 6.9 0.1 2010-2011 565 0.2 0.5 4.2 10.1 32.0 39.3 13.1 0.5 CSF 2003-2007 1,238 0.2 0.4 2.5 10.2 44.0 32.2 9.1 1.3 0.1 0.2 2010-2011 565 0.4 1.4 10.4 52.4 26.2 8.8 0.4 MCF 2003-2007 1,238 0.2 0.2 0.1 0.8 5.3 21.1 54.6 17.8 0.2 2010-2011 565 0.2 0.9 2.5 13.5 52.9 29.6 0.5 C. tropicalis ANF 2003-2007 996 4.1 25.5 49.5 17.4 2.4 0.7 0.1 0.3 2010-2011 318 11.9 37.1 38.7 10.7 1.3 0.3 CSF 2003-2007 996 1.7 31.9 48.4 16.2 1.2 0.4 0.1 0.1 2010-2011 318 0.6 18.9 57.9 17.0 4.7 0.9 MCF 2003-2007 996 4.6 40.2 37.7 15.0 1.7 0.6 0.1 0.2 2010-2011 318 2.2 27.7 50.3 17.3 1.9 0.6 C. krusei ANF 2003-2007 270 1.5 58.9 33.7 5.2 0.4 0.4 2010-2011 79 1.3 7.6 31.6 45.6 12.7 1.3 CSF 2003-2007 270 0.4 51.9 29.3 14.8 3.0 0.7 0.4 2010-2011 79 1.3 2.5 30.4 21.5 39.2 12.9 MCF 2003-2007 270 1.5 10.4 78.1 7.8 2.2 2010-2011 79 1.3 1.3 27.8 68.4 1.3 - Table 4
Summary of fks alterations detected in echinocandin-resistant Candida sp. strains
Organism State or country Year MIC (μg/ml) for each indicated antifungal: 1,3-β-d-Glucan synthase alterations ina: Anidulafungin Caspofungin Micafungin fks1 HS1 fks1 HS2 fks2 HS1b fks2 HS2b Candida glabrata Indiana 2010 1 4 0.06 WT WT F641V WT C. glabrata Belgium 2010 1 1 0.06 WT WT WT WT C. glabrata Michigan 2010 0.25 0.5 0.03 WT WT D648E WT C. glabrata Texas 2010 0.5 0.25 0.03 WT WT F641Y WT C. glabrata Germany 2010 1 0.5 0.5 WT WT L644W WT C. glabrata New York 2010 0.25 0.25 0.5 WT WT WT WT Candida parapsilosis New York 2010 8 2 1 WT WT NT NT C. parapsilosis New York 2010 8 1 1 WT WT NT NT C. parapsilosis Argentina 2010 8 1 1 WT WT NT NT Candida albicans Sweden 2011 0.5 1 1 S654P WT NT NT C. albicans Scotland 2011 0.5 2 1 S629P WT NT NT C. albicans China 2011 0.25 1 0.5 S645P WT NT NT C. glabrata Australia 2011 0.5 0.25 0.12 F625S WT WT WT C. glabrata Canada 2011 1 1 0.25 WT WT S659Y WT C. glabrata Indiana 2011 1 0.5 0.5 WT WT S663Y WT C. glabrata Australia 2011 1 1 0.5 WT WT S663P WT C. glabrata Greece 2011 2 1 1 WT WT S663P WT C. glabrata Louisiana 2011 4 16 2 S629P WT WT WT - Table 5
Frequency of decreased susceptibility of Aspergillus fumigatus to azole antifungal agents by geographic region using CLSI epidemiological cutoff values
Antifungal agent ECVb (μg/ml) No. of isolatesa (% non-wild-type to each antifungal agent) by region North America Europe Latin America Asia-Pacific Total Itraconazole 1 45 (4.4) 34 (0.0) 13 (0.0) 4 (0.0) 96 (2.0) Posaconazole 0.5 45 (15.6) 34 (2.9) 13 (7.7) 4 (0.0) 96 (9.4) Voriconazole 1 45 (2.2) 34 (0.0) 13 (0.0) 4 (0.0) 96 (1.0) - Table 6
MIC distributions for azole and echinocandin antifungal agents tested against isolates of uncommon species of Candida and Aspergillus, as well as non-Candida yeasts and non-Aspergillus molds identified by molecular methods (≥5 isolates per species) in SENTRY, 2010 to 2011
Species (no. tested) Antifungal agenta No. at an MIC/MEC (μg/ml) of: 0.007 0.015 0.03 0.06 0.12 0.25 0.5 1 2 4 8 16 32 64 128 Candida species C. dubliniensis (50) ANF 1 3 17 18 8 3 CSF 2 2 14 23 8 1 MCF 4 6 23 12 4 1 FLC 16 16 17 ITR 1 10 19 14 4 2 PSC 2 7 28 5 7 1 VRC 41 6 2 1 C. fermentati (8) ANF 4 4 CSF 4 2 2 MCF 1 6 1 FLC 1 1 1 3 1 1 ITR 2 4 1 1 PSC 3 3 1 1 VRC 2 2 3 1 C. guilliermondii (19) ANF 1 5 8 4 1 CSF 3 3 3 4 4 2 MCF 1 1 5 4 5 2 1 FLC 1 7 4 3 2 1 1 ITR 4 7 2 5 1 PSC 5 5 4 5 VRC 1 6 7 3 1 1 C. kefyr (16) ANF 8 4 2 2 CSF 1 13 1 1 MCF 6 7 2 1 FLC 1 5 8 2 ITR 1 3 7 3 2 PSC 1 3 7 3 2 VRC 13 3 C. lusitaniae (55) ANF 1 3 2 18 19 11 1 CSF 1 4 12 20 13 5 MCF 2 2 3 7 25 10 5 1 FLC 12 13 11 8 4 4 1 1 1 ITR 1 1 13 16 8 11 4 1 PSC 1 5 10 19 7 11 1 1 VRC 34 12 6 1 1 1 Non-Candida yeasts Cryptococcus neoformans (84) ANF 84 CSF 11 73 MCF 84 FLC 3 14 24 26 15 2 ITR 8 18 24 22 11 1 PSC 1 4 19 30 16 12 2 VRC 4 17 29 29 5 Rhodotorula mucilaginosa (5) ANF 5 CSF 2 3 MCF 5 FLC 5 ITR 2 2 1 PSC 2 2 1 VRC 2 3 Saccharomyces cerevisiae (6) ANF 1 1 2 2 CSF 2 3 1 MCF 5 1 FLC 3 2 1 ITR 2 2 2 PSC 2 2 2 VRC 3 2 1 Trichosporon asahii (9) ANF 9 CSF 1 3 5 MCF 9 FLC 2 5 1 1 ITR 1 1 5 2 PSC 2 3 3 1 VRC 1 2 3 1 1 1 Trichosporon spp. (5) ANF 5 CSF 2 3 MCF 5 FLC 2 2 1 ITR 1 1 2 1 PSC 2 1 1 1 VRC 3 2 Aspergillus species A. flavus SC (19) ANF 16 1 2 CSF 4 9 6 MCF 15 2 2 ITR 12 7 PSC 3 15 1 VRC 11 7 1 A. niger SC (15) ANF 10 3 2 CSF 5 8 1 1 MCF 12 1 2 ITR 8 6 PSC 9 5 VRC 8 4 1 A. terreus SC (7) ANF 3 2 1 1 CSF 3 3 1 MCF 5 1 1 ITR 1 3 3 PSC 4 3 VRC 1 6 Non-Aspergillus molds Gibberella fujikuroi SC (6) ANF 1 5 CSF 6 MCF 6 ITR 1 5 PSC 1 2 1 1 1 VRC 1 1 2 1 1 ↵a ANF, anidulafungin; MCF, micafungin; CSF, caspofungin; ITR, itraconazole; PSC, posaconazole; VRC, voriconazole.
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- Supplemental file 1 -
Table showing MIC distributions for azole and echinocandin antifungal agents tested against isolates of uncommon species of Candida and Aspergillus as well as non-Candida yeasts and non-Aspergillus molds identified by molecular methods (SENTRY, 2010 to 2011)
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