This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowReprints and Permissions
Right arrow Copyright Information
Right arrow Books from ASM Press
Right arrow MicrobeWorld
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by da Matta, V. L. R.
Right arrow Articles by Levin, A. S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by da Matta, V. L. R.
Right arrow Articles by Levin, A. S.

 Previous Article  |  Next Article 

Antimicrobial Agents and Chemotherapy, April 2007, p. 1573-1576, Vol. 51, No. 4
0066-4804/07/$08.00+0     doi:10.1128/AAC.01038-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.

Antifungal Drug Susceptibility Profile of Pichia anomala Isolates from Patients Presenting with Nosocomial Fungemia{triangledown}

Vânia Lúcia Ribeiro da Matta,1* Márcia de Souza Carvalho Melhem,1 Arnaldo Lopes Colombo,2 Maria Luiza Moretti,3 Laura Rodero,4 Gisele Madeira Duboc de Almeida,5 Marilena dos Anjos Martins,1 Silvia Figueiredo Costa,6 Maria Beatriz G. Souza Dias,7 Márcio Nucci,8 and Anna S. Levin6,9

Adolfo Lutz Institute, Secretary of Health, São Paulo State, São Paulo, Brazil,1 Division of Infectious Diseases, Federal University of São Paulo, São Paulo, Brazil,2 Infectious Diseases Division, Faculty of Medical Sciences, Universidade Estadual de Campinas, Campinas, Brazil,3 Facultad de Medicina, Universidad Católica Argentina, Buenos Aires, Argentina,4 Laboratory of Clinical Microbiology, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil,5 Hospital Infection Control Department, LIM 54, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil,6 Hospital Sírio Libanês, São Paulo, Brazil,7 Department of Internal Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil,8 Department of Infectious Diseases, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil9

Received 18 August 2006/ Returned for modification 17 October 2006/ Accepted 13 January 2007


arrow
ABSTRACT
 
In vitro susceptibility of 58 isolates of Pichia anomala to five antifungal drugs using two broth microdilution methods (CLSI and EUCAST) was analyzed. Low susceptibility to itraconazole was observed. Fluconazole, voriconazole, amphotericin B, and caspofungin showed good antifungal activity, although relatively high drug concentrations were necessary to inhibit the isolates.


arrow
TEXT
 
Several reports have pointed to Pichia anomala (anamorph Candida pelliculosa) as a cause of a large spectrum of invasive infections (13, 20, 23, 35), fungemia being the most common presentation (2, 6, 17, 26, 41). Usually, the patients have been treated with amphotericin B (with or without 5-flucytosine) or fluconazole with good clinical outcomes (3, 6, 12, 16, 26, 38). Nonetheless, treatment failures may occur (1, 6, 43), as may cases of breakthrough fungemias in immunocompromised patients receiving prophylaxis with fluconazole (14).

Although P. anomala is considered an emergent hematogenous yeast pathogen, data on the susceptibility of P. anomala to antifungal drugs are scarce (4, 5, 19, 29, 33). The aim of this study was to determine the in vitro susceptibility profile to five antifungal drugs of a large collection of P. anomala isolates from blood cultures of patients with nosocomial fungemia.

For this purpose, 52 nonrelated bloodstream isolates of P. anomala (36 from Brazil, 13 from Argentina, and 3 from Spain) and 6 from unknown clinical specimens (United States) were tested by two broth microdilution methods, those of the Clinical and Laboratory Standards Institute (CLSI; formerly NCCLS) (21) and the European Committee on Antibiotic Susceptibility Testing (EUCAST) (37) guidelines.

We evaluated the activity of amphotericin B (Sigma), itraconazole (Janssen Pharmaceutica), voriconazole (Pfizer, Inc.), and caspofungin (Merck & Co.) at concentrations ranging from 0.015 to 8 µg/ml and of fluconazole (Pfizer, Inc.) at concentrations ranging from 0.12 to 64 µg/ml.

The inhibition criterion adopted to determine the MIC for amphotericin B was the lowest drug concentration which produced complete or nearly complete (≥95%) inhibition compared with the drug-free control well (25). For azoles (21) and caspofungin (24), the lowest concentration which produced ≥50% inhibition was used.

All MICs were determined spectrophotometrically (530 nm) after incubation for 24 h (EUCAST) or 48 h (CLSI). To categorize the isolates as susceptible, we employed the CLSI (21) interpretive criteria for fluconazole (≤8 µg/ml) and itraconazole (≤0.12 µg/ml); for voriconazole, we used a recently established breakpoint (BP) of ≤1 µg/ml (30). Based on pharmacokinetic data, a BP of ≤1 µg/ml was assumed for caspofungin (40) and for amphotericin B (22, 29). The CLSI interpretive criteria were also adopted for EUCAST results for comparison only, as EUCAST BPs have not been defined yet.

In our study, we found an excellent agreement (≤2-fold dilutions) between MIC results generated by the EUCAST and CLSI methods for all antifungal drugs (Table 1). The lowest agreement rate was observed for itraconazole assays, as reported in a previous study testing other Candida species (10). In evaluations of the differences among MICs obtained by the two methods, EUCAST produced statistically significant lower MICs for voriconazole, amphotericin B, and caspofungin (Table 1). However, despite these differences, all isolates were categorized as susceptible by both methods, according to the assumed BPs. Although both methods were suitable to test P. anomala, the 24 h of incubation with the EUCAST method provided a clear spectrophotometric endpoint reading, which represents an advantage by reducing the incubation time.


View this table:
[in this window]
[in a new window]

  		TABLE 1. Distribution of P. anomala isolates according to differences in MIC results obtained by the EUCAST and CLSI methods

No remarkable differences were observed when the geographic distribution of the isolates was considered (data not shown), and so Table 2 presents in a continuous fashion the cumulative percentages of all 58 P. anomala isolates that were found to be susceptible at each dilution throughout the serial dilutions. We could observe that MICs tended to concentrate from the middle to the high end of the range for all the drugs. Although almost all isolates were categorized as being susceptible to fluconazole (Table 2), similar to results from other investigators (19, 29, 33, 42), some studies showed different results (5, 36). Indeed, the modal values, MIC50 and MIC90, of our collection were close to those reported for C. glabrata (8, 9, 11, 27, 28, 34), a species of Candida that is considered to be less susceptible to azoles than Candida albicans.


View this table:
[in this window]
[in a new window]

  		TABLE 2. Antifungal drug susceptibility profile of P. anomala determined by CLSI and EUCAST broth dilution methods

Itraconazole was the triazole with the lowest in vitro activity against P. anomala, as more than 60% of all isolates showed reduced sensitivity to the drug (Table 2). Also, the MIC50 and MIC90 for itraconazole were much higher than those frequently obtained for C. albicans (8, 11, 25, 34) and were similar to those determined for Candida glabrata, Candida krusei, and Candida guilliermondii (4, 10, 11, 18, 25, 34).

Voriconazole was very active against all P. anomala isolates (Table 2), but MICs were usually higher than those reported for C. albicans, Candida parapsilosis, and Candida tropicalis (7, 18, 28, 29, 31, 33). Actually, they were similar to MIC results obtained by other investigators testing C. glabrata and C. krusei (7, 18, 28, 29, 31).

In our study, amphotericin B MICs were tightly clustered between 0.12 and 1.0 µg/ml, and all isolates were considered susceptible to the drug (Table 2). In fact, the resistance of Candida species to amphotericin B is a rare phenomenon that may be associated with the low sensitivity of broth microdilution methods in identifying resistant strains.

Caspofungin presented good in vitro activity against P. anomala, as all isolates were inhibited by ≤1 µg/ml (Table 2). However, their MICs were higher than those usually necessary to inhibit most isolates of C. albicans, C. tropicalis, and C. glabrata. (7, 15, 25, 32). The only other study on the susceptibility of P. anomala to caspofungin generated MIC50 values eight times lower than those in our report. This finding may be explained partially by differences in the incubation times used in the two studies, as we read the CLSI MICs at 48 h instead of 24 h as suggested by Pfaller et al. (32). In fact, we were not able to determine MICs with confidence at 24 h by using the CLSI inoculum, in contrast with the 100-fold-higher EUCAST inoculum. Finally, neither trailing nor paradoxical growth was seen in our series of P. anomala isolates with caspofungin, as observed for some Candida species (25, 39).

In summary, P. anomala did not show intrinsic resistance to any of the drugs studied. Nonetheless, susceptibility to itraconazole was poor. In contrast, fluconazole, voriconazole, amphotericin B, and caspofungin presented good activity against P. anomala, although relatively high drug concentrations were necessary to inhibit the isolates. Altogether, the susceptibility profile of P. anomala was more similar to that of C. glabrata than to that of C. albicans. Trailing and paradoxical growth were not observed in the presence of any antifungal drug tested.

Finally, our study analyzed the largest series studied to date of P. anomala bloodstream isolates tested against five antifungal drugs by two different methods and could establish a reliable susceptibility profile for P. anomala, as an attempt to guide the choice of antifungal drugs for therapy in cases of invasive infections.


arrow
ACKNOWLEDGMENTS
 
We acknowledge Laboratórios Pfizer Ltda., Brazil; Merck Co.; and Janssen Pharmaceutica for donating the antifungal powders.

We thank Manuel Cuenca-Estrella and Richard Hollis for providing isolates from Spain and the United States, respectively; Giovane Coutinho for technical assistance in experiments with caspofungin; and Geraldo R. Godoy for organizing the tables.


arrow
FOOTNOTES
 
* Corresponding author. Mailing address: Instituto Adolfo Lutz, Av Dr. Arnaldo 351, 11° andar, São Paulo, São Paulo, Brazil 01246-901. Phone: 55 11 3068 2900. Fax: 55 11 3085 3505. E-mail: mattav{at}usp.br Back

{triangledown} Published ahead of print on 29 January 2007. Back


arrow
REFERENCES
 
    1
  1. Alter, S. J., and J. Farley. 1994. Development of Hansenula anomala infection in a child receiving fluconazole therapy. Pediatr. Infect. Dis. J. 13:158-159.[CrossRef][Medline]
    2. 2
  2. Aragão, P. A., I. C. Oshiro, E. I. Manrique, C. C. Gomes, L. L. Matsuo, C. Leone, M. L. Moretti-Branchini, and A. S. Levin. 2001. Pichia anomala outbreak in a nursery: exogenous source? Pediatr. Infect. Dis. J. 20:843-848.[CrossRef][Medline]
    3. 3
  3. Bakir, M., N. Cerikcioglu, A. Tirtir, S. Berrak, E. Ozek, and C. Canpolat. 2004. Pichia anomala fungaemia in immunocompromised children. Mycoses 47:231-235.[CrossRef][Medline]
    4. 4
  4. Barchiesi F., A. M Tortorano, L. F. Di Francesco, M. Cogliati, G. Scalise, and M. A. Viviani. 1999. In vitro activity of five antifungal agents against uncommon clinical isolates of Candida spp. J. Antimicrob. Chemother. 43:295-299.[Abstract/Free Full Text]
    5. 5
  5. Barchiesi, F., A. M. Tortorano, L. F. Di Francesco, A. Rigoni, A. Giacometti, E. Spreghini, G. Scalise, and M. A. Viviani. 2005. Genotypic variation and antifungal susceptibilities of Candida pelliculosa clinical isolates. J. Med. Microbiol. 54:279-285.[Abstract/Free Full Text]
    6. 6
  6. Chakrabarti A., K. Singh, A. Narang, S. Singhi, R. Batra, K. L. N. Rao, P. Ray, S. Gopalan, S. Das, V. Gupta, A. K. Gupta, S. M. Bose, and M. M. McNeil. 2001. Outbreak of Pichia anomala infection in the pediatric service of a tertiary-care center in Northern India. J. Clin. Microbiol. 39:1702-1706.[Abstract/Free Full Text]
    7. 7
  7. Chryssanthou, E., and M. Cuenca-Estrella. 2002. Comparison of the Antifungal Susceptibility Testing Subcommittee of the European Committee on Antibiotic Susceptibility Testing proposed standard and the E-test with the NCCLS broth microdilution method for voriconazole and caspofungin susceptibility testing of yeast species. J. Clin. Microbiol. 40:3841-3844.[Abstract/Free Full Text]
    8. 8
  8. Colombo, A. L., Z. Nakagawa, F. Valdetaro, M. L. Branchini, E. J. Kussano, and M. Nucci. 2003. Susceptibility profile of 200 bloodstream isolates of Candida spp. collected from Brazilian tertiary care hospitals. Med. Mycol. 41:235-239.[CrossRef][Medline]
    9. 9
  9. Cuenca-Estrella, M., T. M. Diaz-Guerra, E. Mellado, A. Monzon, and J. L. Rodriguéz-Tudela. 1999. Comparative in vitro activity of voriconazole and itraconazole against fluconazole-susceptible and fluconazole-resistant clinical isolates of Candida species from Spain. Eur. J. Clin. Microbiol. Infect. Dis. 18:432-435.[CrossRef][Medline]
    10. 10
  10. Cuenca-Estrella, M., W. Lee-Yang, M. A. Ciblak, B. A. Arthington-Skaggs, E. Mellado, D. W. Warnock, and J. L. Rodriguez-Tudela. 2002. Comparative evaluation of NCCLS M27-A and EUCAST broth microdilution procedures for antifungal susceptibility testing of Candida species. Antimicrob. Agents Chemother. 46:3644-3647.[Abstract/Free Full Text]
    11. 11
  11. Godoy, P., I. N. Tiraboschi, L. C. Severo, B. Bustamante, B. Calvo, L. P. Almeida, D. A. da Matta, and A. L. Colombo. 2003. Species distribution and antifungal susceptibility profile of Candida spp. bloodstream isolates from Latin American hospitals. Mem. Inst. Oswaldo Cruz 98:401-405.[Medline]
    12. 12
  12. Haron, E., E. Anaissie, F. Dumphy, K. McCredie, and V. Fainstein. 1988. Hansenula anomala fungemia. Rev. Infect. Dis. 10:1182-1186.[Medline]
    13. 13
  13. Kane, S. L., J. F. Dasta, and C. H. Cook. 2002. Amphotericin B lipid complex for Hansenula anomala pneumonia. Ann. Pharmacother. 36:59-62.[Abstract]
    14. 14
  14. Krcmery, V., Jr., E. Oravcova, S. Spanik, M. Mrazova-Studena, J. Trupl, A. Kunova, K. Stopkova-Grey, E. Kukuckova, I. Krupova, A. Demitrovicova, and K. Kralovicova. 1998. Nosocomial breakthrough fungaemia during antifungal prophylaxis or empirical antifungal therapy in 41 cancer patients receiving antineoplastic chemotherapy: analysis of aetiology risk factors and outcome. J. Antimicrob. Chemother. 41:373-380.[Abstract/Free Full Text]
    15. 15
  15. Laverdiere, M., C. Restieri, and F. Habel. 2002. Evaluation of the in vitro activity of caspofungin against bloodstream isolates of Candida species from cancer patients: comparison of Etest and NCCLS reference methods. Int. J. Antimicrob. Agents. 20:468-471.[CrossRef][Medline]
    16. 16
  16. Lopez, F., G. Martin, M. L. Paz, and M. A. Sanz. 1990. Hansenula anomala infection in acute leukemia. Enferm. Infecc. Microbiol. Clin. 8:363-364.[Medline]
    17. 17
  17. Luzzati, R., G. Amalfitano, L. Lazzarini, F. Soldani, S. Bellino, M Solbiati, M. C. Danzi, S. Vento, G. Todeschini, C. Vivenza, and E. Concia. 2000. Nosocomial candidemia in non-neutropenic patients at an Italian tertiary care hospital. Eur. J. Clin. Microbiol. Infect. Dis. 19:602-607.[CrossRef][Medline]
    18. 18
  18. Marco, F., C. Danes, M. Almela, A. Jurado, J. Mensa, J. P. de la Bellacasa, M. Espasa, J. A. Martinez, and M. T. Jimenez de Anta. 2003. Trends in frequency and in vitro susceptibilities to antifungal agents, including voriconazole and anidulafungin of Candida bloodstream isolates. Results from a six-year study (1996-2001). Diagn. Microbiol. Infect. Dis. 46:259-264.[CrossRef][Medline]
    19. 19
  19. Maxwell, M. J., S. A. Messer, R. J. Hollis, L. Boyken, S. Tendolkar, D. J. Diekema, M. A. Pfaller, and the International Fungal Surveillance Participant Group. 2003. Evaluation of Etest method for determining fluconazole and voriconazole MICs for 279 clinical isolates of Candida species infrequently isolated from blood. J. Clin. Microbiol. 41:1087-1090.[Abstract/Free Full Text]
    20. 20
  20. Murphy, N., V. Damjanovic, C. A. Hart, C. R. Buchanan, R. Whitaker, and R. W. I. Cooke. 1986. Infection and colonisation of neonates by Hansenula anomala. Lancet i:291-293.
    21. 21
  21. NCCLS/CLSI. 2002. Reference method for broth dilution antifungal susceptibility testing of yeasts, 2nd ed. Approved standard, M27-A2. National Committee for Clinical Laboratory Standards, Wayne, PA.
    22. 22
  22. Nguyen, M. H., C. J. Clancy, V. L. Yu, Y. C. Yu, A. J. Morris, D. R. Snydman, D. A. Sutton, and M. G. Rinaldi. 1998. Do in vitro susceptibility data predict the microbiologic response to amphotericin B? Results of a prospective study of patients with Candida fungemia. J. Infect. Dis. 177:425-430.[Medline]
    23. 23
  23. Nohinek, B., C. S. Zee-Cheng, W. G. Barnes, L. Dall, and H. R. Gibbs. 1987. Infective endocarditis of a bicuspid aortic valve caused by Hansenula anomala. Am. J. Med. 82:165-168.[CrossRef][Medline]
    24. 24
  24. Odds, F. C., M. Motyl, R. Andrade, J. Bille, E. Canton, M. Cuenca-Estrella, A. Davidson, C. Durussel, D. Ellis, E. Foraker, A. W. Fothergill, M. A. Ghannoum, R. A. Giacobbe, M. Gobernado, R. Handke, M. Laverdiere, W. Lee-Yang, W. G. Merz, L. Ostrosky-Zeichner, J. Peman, S. Perea, J. R. Perfect, M. A. Pfaller, L. Proia, J. H. Rex, M. G. Rinaldi, J. L. Rodriguez-Tudela, W. A. Schell, C. Shields, D. A. Sutton, P. E. Verweij, and D. W. Warnock. 2004. Interlaboratory comparison of results of susceptibility testing with caspofungin against Candida and Aspergillus species. J. Clin. Microbiol. 42:3475-3482.[Abstract/Free Full Text]
    25. 25
  25. Ostrosky-Zeichner, L., J. H. Rex, P. G. Pappas, R. J. Hamill, R. A. Larsen, H. W. Horowitz, W. G. Powderly, N. Hyslop, C. A. Kauffman, J. Cleary, J. E. Mangino, and J. Lee. 2003. Antifungal susceptibility survey of 2,000 bloodstream Candida isolates in the United States. Antimicrob. Agents Chemother. 47:3149-3154.[Abstract/Free Full Text]
    26. 26
  26. Pasqualotto, A. C., T. C. Sukiennik, L. C. Severo, C. S. de Amorim, and A. L. Colombo. 2005. An outbreak of Pichia anomala fungemia in a Brazilian pediatric intensive care unit. Infect. Control Hosp. Epidemiol. 26:553-558.[CrossRef][Medline]
    27. 27
  27. Pfaller, M. A., D. J. Diekema, R. N. Jones, H. S. Sader, A. C. Fluit, R. J. Hollis, S. A. Messer, and the SENTRY Participant Group. 2001. International surveillance of bloodstream infections due to Candida species: frequency of occurrence and in vitro susceptibilities to fluconazole, ravuconazole, and voriconazole of isolates collected from 1997 through 1999 in the SENTRY antimicrobial surveillance program. J. Clin. Microbiol. 39:3254-3259.[Abstract/Free Full Text]
    28. 28
  28. Pfaller, M. A., D. J. Diekema, S. A. Messer, and L. Boyken. 2003. In vitro activities of voriconazole, posaconazole, and four licensed systemic antifungal agents against Candida species infrequently isolated from blood. J. Clin. Microbiol. 41:78-83.[Abstract/Free Full Text]
    29. 29
  29. Pfaller, M. A., D. J. Diekema, S. A. Messer, L. Boyken, R. J. Hollis, and R. N. Jones. 2004. In vitro susceptibilities of rare Candida bloodstream isolates to ravuconazole and three comparative antifungal agents. Diagn. Microbiol. Infect. Dis. 48:101-105.[CrossRef][Medline]
    30. 30
  30. Pfaller, M. A., D. J. Diekema, J. H. Rex, A. Espinel-Ingroff, E. M. Johnson, D. Andes, V. Chaturvedi, M. A Ghannoum, F. C. Odds, M. G. Rinaldi, D. J. Sheehan, P. Troke, T. J. Walsh, and D. W. Warnock. 2006. Correlation of MIC with outcome for Candida species tested against voriconazole: analysis and proposal for interpretive breakpoints. J. Clin. Microbiol. 44:819-826.[Abstract/Free Full Text]
    31. 31
  31. Pfaller, M. A., S. A. Messer, A. Houston, K. Mills, A. Bolmstrom, and R. N. Jones. 2000. Evaluation of the Etest method for determining voriconazole susceptibilities of 312 clinical isolates of Candida species by using three different agar media. J. Clin. Microbiol. 38:3715-3717.[Abstract/Free Full Text]
    32. 32
  32. Pfaller M. A., S. A. Messer, L. Boyken, C. Rice, S. Tendolkar, R. J. Hollis, and D. J. Diekema. 2004. Further standardization of broth microdilution methodology for in vitro susceptibility testing of caspofungin against Candida species by use of an international collection of more than 3,000 clinical isolates. J. Clin. Microbiol. 42:3117-3119.[Abstract/Free Full Text]
    33. 33
  33. Pfaller, M. A., S. A. Messer, L. Boyken, R. J. Hollis, C. Rice, S. Tendolkar, and D. J. Diekema. 2004. In vitro activities of voriconazole, posaconazole, and fluconazole against 4,169 clinical isolates of Candida spp. and Cryptococcus neoformans collected during 2001 and 2002 in the ARTEMIS global antifungal surveillance program. Diagn. Microbiol. Infect. Dis. 48:201-205.[CrossRef][Medline]
    34. 34
  34. Pfaller, M. A., S. A. Messer, R. J. Hollis, R. N. Jones, and D. J. Diekema. 2002. In vitro activities of ravuconazole and voriconazole compared with those of four approved systemic antifungal agents against 6,970 clinical isolates of Candida spp. Antimicrob. Agents Chemother. 46:1723-1727.[Abstract/Free Full Text]
    35. 35
  35. Qadri, S. M., F. Al Dayel, M. J. Strampfer, and B. A. Cunha. 1988. Urinary tract infection caused by Hansenula anomala. Mycopathologia 104:99-101.[CrossRef][Medline]
    36. 36
  36. Reyes, E., S. Barahona, O. Fischman, M. Niklitschek, M. Baeza, and V. Cifuentes. 2004. Genetic polymorphism of clinical and environmental strains of Pichia anomala. Biol. Res. 37(Suppl.):747-757.[Medline]
    37. 37
  37. Rodríguez-Tudela, J. L., F. Barchiesi, J. Bille, E. Chryssanthou, M. Cuenca-Estrella, D. Denning, J. P. Donnelly, B. Dupont, W. Fegeler, C. Moore, M. Richardson, and P. E. Verweij. 2003. Method for the determination of minimum inhibitory concentration (MIC) by broth dilution of fermentative yeasts. Clin. Microbiol. Infect. 9:i-viii.
    38. 38
  38. Sekhon, A. S., K. Kowalewska-Grochowska, A. K. Garg, and W. Vaudry. 1992. Hansenula anomala fungemia in an infant with gastric and cardiac complications with a review of the literature. Eur. J. Epidemiol. 8:305-308.[Medline]
    39. 39
  39. Stevens, D. A., M. Espiritu, and R. Parmar. 2004. Paradoxical effect of caspofungin: reduced activity against Candida albicans at high drug concentrations. Antimicrob. Agents Chemother. 48:3407-3411.[Abstract/Free Full Text]
    40. 40
  40. Stone, J. A., S. D. Holland, P. J. Wickersham, A. Sterrett, M. Schwartz, C. Bonfiglio, M. Hesney, G. A. Winchell, P. J. Deutsch, H. Greenberg, T. L. Hunt, and S. A. Waldman. 2002. Single- and multiple-dose pharmacokinetics of caspofungin in healthy men. Antimicrob. Agents Chemother. 46:739-745.[Abstract/Free Full Text]
    41. 41
  41. Thuler, L. C., S. Faivichenco, E. Velasco, C. A. Martins, C. R. Nascimento, and I. A. Castilho. 1997. Fungaemia caused by Hansenula anomala- an outbreak in a cancer hospital. Mycoses 40:193-196.[Medline]
    42. 42
  42. Tortorano, A. M., A. L. Rigoni, E. Biraghi, A. Prigitano, M. A. Viviani, and the FIMUA-ECMM Candidaemia Study Group. 2003. The European Confederation of Medical Mycology (ECMM) survey of candidaemia in Italy: antifungal susceptibility patterns of 261 non-albicans Candida isolates from blood. J. Antimicrob. Chemother. 52:679-682.[Abstract/Free Full Text]
    43. 43
  43. Wong, A. R., H. Ibrahim, H. Van Rostenberghe, Z. Ishak, and M. J. Radzi. 2000. Hansenula anomala infection in a neonate. J. Paediatr. Child Health 36:1.

Antimicrobial Agents and Chemotherapy, April 2007, p. 1573-1576, Vol. 51, No. 4
0066-4804/07/$08.00+0     doi:10.1128/AAC.01038-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.




This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowReprints and Permissions
Right arrow Copyright Information
Right arrow Books from ASM Press
Right arrow MicrobeWorld
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by da Matta, V. L. R.
Right arrow Articles by Levin, A. S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by da Matta, V. L. R.
Right arrow Articles by Levin, A. S.

Copyright © 2009 by the American Society for Microbiology.   For an alternate route to Journals.ASM.org, visit: http://intl-journals.asm.org | More Info»