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Antimicrobial Agents and Chemotherapy, October 2003, p. 3149-3154, Vol. 47, No. 10
0066-4804/03/$08.00+0     DOI: 10.1128/AAC.47.10.3149-3154.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.

Antifungal Susceptibility Survey of 2,000 Bloodstream Candida Isolates in the United States

Luis Ostrosky-Zeichner,1* John H. Rex,1 Peter G. Pappas,2 Richard J. Hamill,3 Robert A. Larsen,4 Harold W. Horowitz,5 William G. Powderly,6 Newton Hyslop,7 Carol A. Kauffman,8 John Cleary,9 Julie E. Mangino,10 and Jeannette Lee2

University of Texas—Houston Medical School, Houston, Texas,1 University of Alabama at Birmingham, Birmingham, Alabama,2 Baylor University, Houston, Texas,3 University of Southern California, Los Angeles, California,4 New York Medical College, Valhalla, New York,5 Washington University, St. Louis, Missouri,6 Tulane Medical Center, New Orleans, Louisiana,7 University of Michigan and VA Medical Center, Ann Arbor, Michigan,8 University of Mississippi, Jackson, Mississippi,9 Ohio State University, Columbus, Ohio,10

Received 3 June 2003/ Returned for modification 29 June 2003/ Accepted 3 July 2003

Candida bloodstream isolates (n = 2,000) from two multicenter clinical trials carried out by the National Institute of Allergy and Infectious Diseases Mycoses Study Group between 1995 and 1999 were tested against amphotericin B (AMB), flucytosine (5FC), fluconazole (FLU), itraconazole (ITR), voriconazole (VOR), posaconazole (POS), caspofungin (CFG), micafungin (MFG), and anidulafungin (AFG) using the NCCLS M27-A2 microdilution method. All drugs were tested in the NCCLS-specified RPMI 1640 medium except for AMB, which was tested in antibiotic medium 3. A sample of isolates was also tested in RPMI 1640 supplemented to 2% glucose and by using the diluent polyethylene glycol (PEG) in lieu of dimethyl sulfoxide for those drugs insoluble in water. Glucose supplementation tended to elevate the MIC, whereas using PEG tended to decrease the MIC. Trailing growth occurred frequently with azoles. Isolates were generally susceptible to AMB, 5FC, and FLU. Rates of resistance to ITR approached 20%. Although no established interpretative breakpoints are available for the candins (CFG, MFG, and AFG) and the new azoles (VOR and POS), they all exhibited excellent antifungal activity, even for those strains resistant to the other aforementioned agents.

* Corresponding author. Mailing address: Division of Infectious Diseases, University of Texas—Houston Medical School, 6431 Fannin JFB 1.728, Houston, TX 77030. Phone: (713) 500-6733. Fax: (713) 500-5495. E-mail: luis.ostrosky-zeichner{at}uth.tmc.edu.

Antimicrobial Agents and Chemotherapy, October 2003, p. 3149-3154, Vol. 47, No. 10
0066-4804/03/$08.00+0     DOI: 10.1128/AAC.47.10.3149-3154.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.



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