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Susceptibility

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

Luis Ostrosky-Zeichner, John H. Rex, Peter G. Pappas, Richard J. Hamill, Robert A. Larsen, Harold W. Horowitz, William G. Powderly, Newton Hyslop, Carol A. Kauffman, John Cleary, Julie E. Mangino, Jeannette Lee
Luis Ostrosky-Zeichner
1University of Texas—Houston Medical School, Houston, Texas
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  • For correspondence: luis.ostrosky-zeichner@uth.tmc.edu
John H. Rex
1University of Texas—Houston Medical School, Houston, Texas
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Peter G. Pappas
2University of Alabama at Birmingham, Birmingham, Alabama
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Richard J. Hamill
3Baylor University, Houston, Texas
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Robert A. Larsen
4University of Southern California, Los Angeles, California
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Harold W. Horowitz
5New York Medical College, Valhalla, New York
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William G. Powderly
6Washington University, St. Louis, Missouri
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Newton Hyslop
7Tulane Medical Center, New Orleans, Louisiana
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Carol A. Kauffman
8University of Michigan and VA Medical Center, Ann Arbor, Michigan
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John Cleary
9University of Mississippi, Jackson, Mississippi
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Julie E. Mangino
10Ohio State University, Columbus, Ohio
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Jeannette Lee
2University of Alabama at Birmingham, Birmingham, Alabama
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DOI: 10.1128/AAC.47.10.3149-3154.2003
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Tables

  • TABLE 1.

    MIC50 and MIC90 summary for the most common Candida spp. with nine antifungal agentsa

    Species (n)MIC (μg/ml)
    AMB5FCFLUITRPOSVORAFGCFGMFG
    50%90%50%90%50%90%50%90%50%90%50%90%50%90%50%90%50%90%
    C. albicans (733)0.060.250.1310.2520.060.50.030.130.030.060.030.030.50.50.030.03
    C. glabrata (458)0.130.50.130.1383214120.2510.030.130.510.030.06
    C. parapsilosis (391)0.130.50.130.13120.130.250.030.130.030.06222212
    C. tropicalis (307)0.130.50.130.50.5160.1310.0610.0620.030.130.510.030.06
    C. krusei (50)0.250.543232>640.510.250.50.510.060.13120.130.25
    C. lusitaniae (20)0.130.50.130.130.520.060.250.030.130.030.060.060.25120.062
    C. dubliniensis (18)0.030.130.130.130.130.50.030.060.030.060.030.030.030.060.50.50.030.03
    • ↵ a Shown are the results for MIC-0 at 24 h for AMB and MIC-2 at 48 h for all other drugs. n, number of isolates.

  • TABLE 2.

    MICs for infrequent Candida spp.a

    Species (n)Median (range) MIC (μg/ml)
    AMB5FCFLUITRPOSVORAFGCFGMFG
    C. guilliermondii (9)0.06 (0.03-0.25)0.13 (0.13-64)4 (0.25-8)0.5 (0.03-2)0.06 (0.03-0.25)0.06 (0.03-0.13)1 (0.06-2)1 (0.5-2)0.5 (0.06-0.5)
    C. kefyr (4)0.5 (0.13-0.5)0.131 (0.13-1)0.13 (0.03-0.5)0.06 (0.06-0.25)0.030.06 (0.03-0.5)0.5 (0.5-1)0.06 (0.06-0.5)
    C. lipolytica (2)14 (2-4)16 (2-16)2 (0.06-2)0.25 (0.03-0.25)0.06 (0.03-0.06)1 (0.03-1)2 (0.5-2)0.5 (0.13-0.5)
    C. rugosa (7)0.13 (0.03-0.5)0.25 (0.13-0.25)4 (1-16)0.06 (0.03-1)0.03 (0.03-1)0.03 (0.03-0.25)0.03 (0.03-4)2 (1-2)0.06 (0.03->64)
    C. sphaerica (1)0.130.1340.130.130.030.1320.25
    • ↵ a Shown are the results for MIC-0 at 24 h for AMB and MIC-2 at 48 h for all other drugs. n, no. of isolates.

  • TABLE 3.

    Resistance rates for antifungals with published interpretive breakpointsa

    Species (n)Frequency (%) of resistance to:
    AMB5FCFLUITR
    C. albicans (733)0358
    C. glabrata (458)0.80.2851
    C. parapsilosis (391)2.5224
    C. tropicalis (307)0.36812
    C. krusei (50)2123420
    C. lusitaniae (20)0000
    C. dubliniensis (18)0000
        Overall0.83618
    • ↵ a Resistance is defined as the following MICs (in micrograms per milliliter): AMB, >1; 5FC, ≥32; FLU, ≥64; and ITR, ≥1. n, no. of isolates.

  • TABLE 4.

    Cross-distribution of azole congener MICsa

    DrugMIC (μg/ml)No. of isolates with MIC combination
    VOR MIC (μg/ml)POS MIC (μg/ml)
    0.030.060.130.250.5124816>160.030.060.130.250.5124816>16
    FLU0.1319151111
    0.2536815322215
    0.529353933211113
    11824626532314
    2602720531123
    414304325441112
    8615556635541
    1623825483521
    323242115275112
    6454133921
    >64142213971611217
    ITR0.03374171111
    0.06296160295321211
    0.13116109271061
    0.25247652311761
    0.58231759109428312
    132575080233
    27234102328424
    4121122017213
    812221
    1612221
    >1641256412
    • ↵ a Distribution of VOR MICs by FLU MICs (r2 = 0.48) and POS MICs by ITR MICs (r2 = 0.65). All MICs are MIC-2 at 48 h.

  • TABLE 5.

    MIC variations by differences in test medium and solvent when compared to RPMI and standard solvent for 344 Candida spp. isolatesa

    Drug% of isolates for which result of MIC comparison applies in:
    RPMI-2% GLURPMI-2% GLU + PEG solventRPMI + PEG solvent
    IdenticalUp to 2 dilutions higherUp to 2 dilutions lowerIdenticalUp to 2 dilutions higherUp to 2 dilutions lowerIdenticalUp to 2 dilutions higherUp to 2 dilutions lower
    AFG48502
    CFG513018
    FLU54142
    5FC83116
    ITR2857145204360634
    POS6814146612669227
    VOR813146912773125
    • ↵ a Data are shown for MIC-2 at 48 h. GLU, glucose.

  • TABLE 6.

    Frequency of the trailing phenomenon by drug and Candida spp.a

    SpeciesFrequency (%) of trailing with:
    5FCFLUITRPOSVORAFGCFGMFG
    C. albicans 9121366132
    C. glabrata 114293032222
    C. krusei 1814252014264
    C. parapsilosis 371142161211
    C. tropicalis 422191722132
    • ↵ a Trailing growth was defined as an eightfold increase of the MIC-2 between 24 and 48 h.

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Antifungal Susceptibility Survey of 2,000 Bloodstream Candida Isolates in the United States
Luis Ostrosky-Zeichner, John H. Rex, Peter G. Pappas, Richard J. Hamill, Robert A. Larsen, Harold W. Horowitz, William G. Powderly, Newton Hyslop, Carol A. Kauffman, John Cleary, Julie E. Mangino, Jeannette Lee
Antimicrobial Agents and Chemotherapy Sep 2003, 47 (10) 3149-3154; DOI: 10.1128/AAC.47.10.3149-3154.2003

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Antifungal Susceptibility Survey of 2,000 Bloodstream Candida Isolates in the United States
Luis Ostrosky-Zeichner, John H. Rex, Peter G. Pappas, Richard J. Hamill, Robert A. Larsen, Harold W. Horowitz, William G. Powderly, Newton Hyslop, Carol A. Kauffman, John Cleary, Julie E. Mangino, Jeannette Lee
Antimicrobial Agents and Chemotherapy Sep 2003, 47 (10) 3149-3154; DOI: 10.1128/AAC.47.10.3149-3154.2003
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KEYWORDS

antifungal agents
Candida
candidiasis

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