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JAC Advance Access originally published online on December 19, 2003
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Journal of Antimicrobial Chemotherapy (2004) 53, 283-289
© 2004 The British Society for Antimicrobial Chemotherapy

National surveillance of species distribution in blood isolates of Candida species in Japan and their susceptibility to six antifungal agents including voriconazole and micafungin

Shunji Takakura1,*, Naoko Fujihara1, Takashi Saito2, Toyoichiro Kudo1, Yoshitsugu Iinuma1, Satoshi Ichiyama1 and the Japan Invasive Mycosis Surveillance Study Group

1 Departments of Clinical Laboratory Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto 6068507; 2 KKR Takamatsu Hospital, Takamatsu, Kagawa 7600018, Japan

Received 7 August 2003; returned 23 September 2003; revised 21 October 2003; accepted 5 November 2003

Objectives: The aim of this study was to evaluate species distribution and antifungal susceptibility of Candida blood isolates in Japan.

Methods: In a 1 year surveillance programme, 535 Candida blood isolates were collected. Identification of species was followed by examination with the broth microdilution method, as described in NCCLS M27-A2, of antifungal susceptibility to six agents, including voriconazole and micafungin, with readings after 24 and 48 h of incubation.

Results: The overall species distribution was: 41% Candida albicans, 23% Candida parapsilosis, 18% Candida glabrata, 12% Candida tropicalis and 2% Candida krusei. The concentrations of fluconazole necessary to inhibit 90% of the isolates (MIC90) at 24/48 h were 0.25/1 mg/L for C. albicans, 0.5/2 mg/L for C. parapsilosis, 4/32 mg/L for C. glabrata and 4/>128 mg/L for C. tropicalis. Percentages of fluconazole resistance were 1.8% for C. albicans, 0.8% for C. parapsilosis, 5.2% for C. glabrata and 3.2% for C. tropicalis, taking the tendency of trailing growth of C. tropicalis into account. MIC90 of voriconazole was 0.5 mg/L, although 35% of isolates less susceptible (>=16 mg/L) to fluconazole showed resistance (>=2 mg/L). Micafungin was very active against all species (MIC90, 0.03 mg/L) except for C. parapsilosis (MIC90, 2 mg/L).

Conclusions: These data suggest that, in Japan, the species distribution of Candida bloodstream infections and the fluconazole resistance rate are similar to those reported previously in North America and Europe. Voriconazole and micafungin appear to have strong in vitro activity against Candida blood isolates, although continuing surveillance and further clinical research are needed.

Keywords: candidaemia, triazoles, echinocandins

* Corresponding author. Tel: +81-75-751-4914; Fax: +81-75-751-3233; E-mail: stakakr{at}kuhp.kyoto-u.ac.jp


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