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Species Distribution and Antifungal Susceptibility (AFS) Patterns for Candida
Bloodstream Isolates from the SENTRY Participants Group [Europe] 1999 – 2000
INTRODUCTION
RESULTS
TABLE 1: Geographic location and number of isolates
of yeast blood stream infections due to Candida spp.
The SENTRY Antimicrobial Surveillance Program is a
longitudinal surveillance program designed to track
antimicrobial resistance trends on a global scale.
During the 24-month study period a total of 138 Candida BSIs
were reported by 13 European SENTRY Program participants
(Figure, table 1). The difference in the proportion of BSIs due
to C. albicans varied considerably among the various
participating sites. Although the numbers were quite small at
some locations, the percentage ranged from 40% to 80% for
institutions with  10 isolates. Overall, non-C. albicans species
were more frequent in the south countries of Europe (Italy,
Spain, Turkey, Israel) compared to the other countries – 46%
compared to 36% (data not shown).
In the present study, we focused on BSI caused by Candida
spp. and described the variations in species and antifungal
susceptibility for 3 azoles compounds among isolates from the
13 medical centers in 10 European countries (including Israel
and Turkey).
The frequency of BSIs due to the various species of Candida
is presented in Table 2. The distribution of some non- C.
albicans species (in particular C. parapsilosis and C.
tropicalis) show differences compared to that reported earlier
by Pfaller et al. (1999).
Surveillance programs of blood stream infections (BSI) are
essential sources of information to identify antimicrobial
resistance trends and to detect emerging pathogens. Candida
BSI are important as they currently rank as the fourth most
common cause of nosocomial BSI with a mortality remaining
high despite appropriate antifungal treatment.
MATERIALS AND METHODS
All fungal blood culture isolates were identified at the
participating institutions by the routine method in use at each
laboratory. The isolates were sent to the University of Iowa
College of Medicine (Iowa City) for storage and further
characterization by reference identification and susceptibility
testing methods.
Guy Prod’hom
Institue de Microbiologie
Rue du Bugnon 44, Lausanne, Switzerland CH-1011
Phone: 41-21-314-4077 Fax: 41-21-314-4060
Email:[email protected]
G. Prod’hom1, J. Bille1, R. Jones2, and Sentry Participants Group 3[Europe]
1Univ. Hosp., Lausanne, Switzerland; 2The JONES Group/JMI Laboratories, North Liberty, IA
Poster # 266
Table 3 summarizes the in vitro antifungal activities of
fluconazole, itraconazole and ravuconazole. A broad range of
MICs was observed with each antifungal agent. The majority
of strains were susceptible to the 3 azoles.
Ravuconazole show lower MICs than itraconazole against
C. albicans, C. glabrata, C. parapsilosis and C. tropicalis BSI
isolates.
Geographic Location, European SENTRY Program 1999 - 2000
TABLE 3. Antifungal activities of fluconazole, itraconazole and
ravuconazole against BSI isolates of Candida spp.
1. C. albicans represented 57% of 138 Candida BSI isolates from
13 hospitals in 10 European countries in 1999-2000.
MIC (mg/l)
Country
No. of Isolates
% Candida albicans*
Belgium
1
-
England
3
-
France
15
60
Germany
10
40
Israel
18
39
Italy – 1
2
-
Italy – 2
17
71
Spain – 1
16
50
Spain – 2
7
-
Sweden
4
-
14
79
Switzerland
Species
C. albicans
C. glabrata
C. krusei
No. of
Isolates
79
17
5
Antifungal
Agents
%
Resistanta
Range
50%
90%
Fluconazole
0.12-0.5
0.25
0.25
0
Itraconazole
0.015-0.25
0.03
0.06
0
Ravuconazole
0.006-0.06
0.006
0.015
Fluconazole
0.12-128
4
32
5.9
Itraconazole
0.06-4
0.5
2
41.2
Ravuconazole
0.006-2
0.12
1
Fluconazole
4-64
16
64
Turkey – 1
15
67
Turkey – 2
16
44
Itraconazole
0.25-2
0.5
2
138
57
Ravuconazole
0.12-1
0.25
1
Overall
C. parapsilosis
*only for institutions with >10 isolates
19
C. tropicalis
14
2. The results document the excellent in vitro activities of
fluconazole, itraconazole, ravuconazole in particular with no
resistance in C. albicans, C. parapsilosis
and C. tropicalis.
3. Ravuconazole was more potent in vitro than itraconazole for
all species tested.
4. Continued surveillance at an international level is important to
monitor any change in species distribution and antifungal
susceptibilty among invasive strains of Candida species and
other fungal pathogens.
European SENTRY Participants3
Country
40.0
Belgium
England
Fluconazole
0.25-2
1
2
0
Itraconazole
0.06-0.5
0.12
0.25
0
0.006-0.06
0.03
0.06
Ravuconazole
TABLE 2: Species Distribution of Candida BSI, European
SENTRY Program 1999-2000 compared to 1997
CONCLUSIONS
France
Germany
Israel
Fluconazole
0.12-16
1
2
0
Itraconazole
0.03-1
0.12
0.5
7.1
Italy – 1
Italy – 2
Spain – 1
Ravuconazole
0.06
0.25
Spain – 2
% of Isolates
SUSCEPTIBILITY TESTING
Candida spp.b
Sweden
Antifungal susceptibilitly testing of Candida isolates, was
performed by the reference broth microdilution method
described by the National Committee for Clinical Laboratory
Standards (NCCLS). Interpretive criteria for fluconazole and
itraconazole were those published by Rex et al. and the
NCCLS: isolates were classified as resistant if the MIC was >
64 mg/l for fluconazole. This breakpoint was apply to all
Candida species (including C. glabrata) with the exception of
C. krusei, which is considered inherently resistant to
fluconazole. For itraconazole, isolates were classified as
resistant if the MIC was > 1 mg/l. No breakpoints were applied
for ravuconazole.
0.006-1
Species
1999-2000
(138 isolates)
4
1997*
(170 isolates)
Fluconazole
0.25-16
0.25
16
0
Itraconazole
0.06-2
0.12
2
25.0
0.006-0.5
0.012
0.5
Ravuconazole
England
Belgiu
m
Germany
France
Switzerland
Spain
Italy
C. albicans
57
53
C. glabrata
12
12
C. kefyr
1
0
C. krusei
4
1
C. lusitaniae
1
0
C. parapsilosis
14
21
C. tropicalis
10
6
0
7
C. spp
Israel
Turkey
*Pfaller et al., 1999
Sweden
Switzerland
Turkey – 1
Turkey – 2
All organisms
138
Fluconazole
0.12-128
0.25
4
2.2
Itraconazole
0.015-4
0.06
0.5
8.0
Ravuconazole
0.006-2
0.006
0.25
Site Name
Univ. Libre de Bruxelles
- Hôpital Erasme
St. Thomas's Hospital
Medical School
CHU de Lille, Hôpital
Calmette
Klinikum der J. W.
Goethe Universität
Chaim Sheba
Medical Center
Policlinico A. Gemelli
Universita degli Studi
di Genova
University Hospital
V. de Macarena
Hospital Ramon y Cajal
University Hospital
University Hospital CHUV
Hacettepe Universitesi
Tip Fakultesi
Marmara Universitesi
Tip Fakultesi
b: Includes C. kefyr (two isolates) and C. lusitaniae (two isolates).
Investigator
Name
Brussels
M. Struelens
London
G. French
Lille
M. Roussel
Delvallez
Frankfurt
P. Shah
Tel-Hashomer
Roma
N. Keller
G. Fadda
Genova
G. Schito
Sevilla
Madrid
Linkoping
A. Pascual
R. Canton
Moreno
H. Hanberger
Lausanne
J. Bille
Ankara
D. Gur
Istanbul
V. Korten
European SENTRY Scientific Adisory Committee (ESSAC)
Prof. J. Bille
Prof. M. Struelens
a: % resistant, percent resistant by using NCCLS interpretive criteria :
fluconazole resistance at > 64 mg/l and itraconazole resistance at > 1 mg/l,
ravuconazole: no interpretive criteria.
City
Prof. R. Canton
Prof. P. Shah
Prof. G. French
REFERENCES
NCCLS (1997) Approved standard M27-A.
Rex JH et al. Clin Infect Dis (1997) 24:235-247.
Pfaller M. A., et al. Diagn Microbiol Infect Dis (1999); 35:19-25.
A156-21