In vitro activity of seven systemically active antifungal agents against a large global collection of rare Candida species as determined by CLSI broth microdilution methods

D J Diekema; S A Messer; L B Boyken; R J Hollis; J Kroeger; S Tendolkar; M A Pfaller

doi:10.1128/JCM.00942-09

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In vitro activity of seven systemically active antifungal agents against a large global collection of rare Candida species as determined by CLSI broth microdilution methods

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In vitro activity of seven systemically active antifungal agents against a large global collection of rare Candida species as determined by CLSI broth microdilution methods

D J Diekema, S A Messer, L B Boyken, R J Hollis, J Kroeger, S Tendolkar and M A Pfaller

Journal of clinical microbiology, Vol.47(10), pp.3170-3177

10/2009

DOI: 10.1128/JCM.00942-09

PMCID: PMC2756931

PMID: 19710283

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Abstract

Five Candida species (C. albicans, C. glabrata, C. tropicalis, C. parapsilosis, and C. krusei) account for over 95% of invasive candidiasis cases. Some less common Candida species have emerged as causes of nosocomial candidiasis, but there is little information about their in vitro susceptibilities to antifungals. We determined the in vitro activities of fluconazole, voriconazole, posaconazole, amphotericin B, anidulafungin, caspofungin, and micafungin against invasive, unique patient isolates of Candida collected from 100 centers worldwide between January 2001 and December 2007. Antifungal susceptibility testing was performed by the CLSI M27-A3 method. CLSI breakpoints for susceptibility were used for fluconazole, voriconazole, anidulafungin, caspofungin, and micafungin, while a provisional susceptibility breakpoint of < or = 1 microg/ml was used for amphotericin and posaconazole. Of 14,007 Candida isolates tested, 658 (4.7%) were among the less common species. Against all 658 isolates combined, the activity of each agent, expressed as the MIC50/MIC90 ratio (and the percentage of susceptible isolates) was as follows: fluconazole, 1/4 (94.8%); voriconazole, 0.03/0.12 (98.6%); posaconazole, 0.12/0.5 (95.9%); amphotericin, 0.5/2 (88.3%); anidulafungin, 0.5/2 (97.4%); caspofungin, 0.12/0.5 (98.0%); and micafungin, 0.25/1 (99.2%). Among the isolates not susceptible to one or more of the echinocandins, most (68%) were C. guilliermondii. All isolates of the less common species within the C. parapsilosis complex (C. orthopsilosis and C. metapsilosis) were susceptible to voriconazole, posaconazole, anidulafungin, caspofungin, and micafungin. Over 95% of clinical isolates of the rare Candida species were susceptible to the available antifungals. However, activity did vary by drug-species combination, with some species (e.g., C. rugosa and C. guilliermondii) demonstrating reduced susceptibilities to commonly used agents such as fluconazole and echinocandins.

Antifungal Agents - pharmacology

Microbial Sensitivity Tests

Humans

Candida - drug effects

Candidiasis - microbiology

Candida - isolation & purification

Drug Resistance, Fungal

Details

Title: Subtitle: In vitro activity of seven systemically active antifungal agents against a large global collection of rare Candida species as determined by CLSI broth microdilution methods
Creators: D J Diekema - Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, IA 52242, USA
S A Messer
L B Boyken
R J Hollis
J Kroeger
S Tendolkar
M A Pfaller
Resource Type: Journal article
Publication Details: Journal of clinical microbiology, Vol.47(10), pp.3170-3177
DOI: 10.1128/JCM.00942-09
PMID: 19710283
PMCID: PMC2756931
NLM abbreviation: J Clin Microbiol
ISSN: 0095-1137
eISSN: 1098-660X
Publisher: United States
Language: English
Date published: 10/2009
Academic Unit: Infectious Diseases; Epidemiology; Pathology; Internal Medicine
Record Identifier: 9983986370002771

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