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Antimicrobial Agents and Chemotherapy, July 2001, p. 2129-2133, Vol. 45, No. 7
0066-4804/01/$04.00+0   DOI: 10.1128/AAC.45.7.2129-2133.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.

Prospective Study of Candida Species in Patients at a Comprehensive Cancer Center

Amar Safdar,1,dagger Vishnu Chaturvedi,2 Emily W. Cross,3 Steven Park,3 Edward M. Bernard,1 Donald Armstrong,1 and David S. Perlin3,*

Infectious Diseases Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center and Department of Medicine, Weill Medical College of Cornell University,1 and The Public Health Research Institute,3 New York, and Mycology Laboratory, Axelrod Institute, New York State Department of Health, Albany,2 New York

Received 24 July 2000/Returned for modification 20 January 2001/Accepted 11 April 2001

Since most nosocomial systemic yeast infections arise from the endogenous flora of the patient, we prospectively evaluated the species stratification and antifungal susceptibility profile of Candida spp. associated with heavy colonization and systemic infection in patients at Memorial Sloan-Kettering Cancer Center in New York. A total of 349 Candida isolates were obtained from 223 patients during the later half of 1998. Cancer was the most common underlying disease, occurring in 91% of the patients, including 61.8% with organ and 23.7% with hematological malignancies; 4.4% of the patients had AIDS. Candida albicans was the predominant species (67.3%); among 114 non-albicans Candida spp., C. glabrata (45.6%) was the most frequent, followed by C. tropicalis (18.4%), C. parapsilosis (16.6%), and C. krusei (9.6%). The overall resistance to triazole-based agents among all yeast isolates was 9.4 and 10.8% for fluconazole and itraconazole, respectively. A total of 5% of C. albicans strains were resistant to triazole antifungals, whereas 30.8 and 46.2% of C. glabrata strains were resistant to fluconazole (MIC >=  64 µg/ml) and itraconazole (MIC >=  1 µg/ml), respectively. A significant association was observed between prior treatment with triazole and isolation of fluconazole-resistant C. albicans (P = 0.005, OR 36), although this relationship was not seen in C. glabrata isolates (P = 0.4). This study reinforces the importance of periodic, prospective surveillance of clinical fungal isolates to determine appropriate prophylactic, empiric, and preemptive antifungal therapy for the highly susceptible patient population.

* Corresponding author. Mailing address: The Public Health Research Institute, 455 First Ave., New York, NY 10021. Phone: (212) 578-0820. Fax: (212) 578-0804. E-mail: perlin{at}phri.nyu.edu.

dagger Present address: Division of Infectious Diseases, Department of Medicine, University of South Carolina School of Medicine, Columbia, S.C.

Antimicrobial Agents and Chemotherapy, July 2001, p. 2129-2133, Vol. 45, No. 7
0066-4804/01/$04.00+0   DOI: 10.1128/AAC.45.7.2129-2133.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.


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