JAC Advance Access originally published online on September 1, 2003
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Journal of Antimicrobial Chemotherapy (2003) 52, 679-682
© 2003 The British Society for Antimicrobial Chemotherapy
The European Confederation of Medical Mycology ECMM) survey of candidaemia in Italy: antifungal susceptibility patterns of 261 non-albicans Candida isolates from blood
Istituto di Igiene e Medicina Preventiva, Università degli Studi – IRCCS Ospedale Maggiore di Milano, via F. Sforza 35, 20122 Milano, Italy
Received 14 April 2003; returned 23 May 2003; revised 17 June 2003; accepted 26 June 2003
Objectives: To analyse the in vitro antifungal susceptibility of 261 non-albicans Candida bloodstream strains isolated during the European Confederation of Medical Mycology survey of candidaemia performed in Lombardia, Italy (September 1997–December 1999).
Methods: In vitro susceptibility to flucytosine, fluconazole, itraconazole, posaconazole and voriconazole was determined using the broth microdilution method described in the NCCLS M27-A guidelines. Etest strips were used to assess susceptibility to amphotericin B. In vitro findings were correlated with the patient’s underlying condition and previous antifungal treatment.
Results: MICs (mg/L) at which 90% of the strains were inhibited were, respectively, 2 for flucytosine, 8 for fluconazole, 0.5 for itraconazole, 0.25 for voriconazole and 0.25 for posaconazole. Amphotericin B MIC endpoints were <0.50 mg/L in all the isolates tested. Flucytosine resistance was detected in 19 isolates (7%), mainly among Candida tropicalis strains (30%). Innate or secondary fluconazole resistance was detected in 13 strains (5%). Among the 13 patients with fluconazole-resistant Candida bloodstream infection, three were HIV positive, including one treated with fluconazole for oral candidosis; the four who were HIV negative had received the azole during the 2 weeks preceding the candidaemia. Cross-resistance among fluconazole and other azoles was a rare event.
Conclusions: Resistance is still uncommon in non-albicans Candida species recovered from blood cultures. However, in fungaemias caused by C. tropicalis, Candida glabrata and Candida krusei, there is a high prevalence of resistance to fluconazole and flucytosine. Fluconazole resistance should be suspected in patients treated previously with azoles, mainly those with advanced HIV infection.
Keywords: flucytosine, fluconazole, itraconazole, posaconazole, voriconazole
* Corresponding author. Tel: +39-02-55033487/+39-02-50320600; Fax: +39-02-50320597; E-mail: annamaria.tortorano{at}unimi.it
The FIMUA-ECMM candidaemia study group are listed in the Acknowledgements.
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