Species distribution and antifungal susceptibility profile of Candida spp. bloodstream isolates from Latin American hospitals

From March 1999 to March 2000, we conducted a prospective multicenter study of candidemia involving five tertiary care hospitals from four countries in Latin America. Yeast isolates were identified by classical methods and the antifungal susceptibility profile was determined according to the National Committee for Clinical Laboratory Standards microbroth assay method. During a 12 month-period we were able to collect a total of 103 bloodstream isolates of Candida spp. C. albicans was the most frequently isolated species accounting for 42 percent of all isolates. Non-albicans Candida species strains accounted for 58 percent of all episodes of candidemia and were mostly represented by C. tropicalis (24.2 percent) and C. parapsilosis (21.3 percent). It is noteworthy that we were able to identify two cases of C. lusitaniae from different institutions. In our casuistic, non-albicans Candida species isolates related to candidemic episodes were susceptible to fluconazole. Continuously surveillance programs are needed in order to identify possible changes in the species distribution and antifungal susceptibility patterns of yeasts that may occurs after increasing the use of azoles in Latin American hospitals

Fluconazole susceptibility of Brazilian Candida isolates assessed by a disk diffusion method

The increasing magnitude of antifungal resistance as well as the advent of new antifungal drugs has generated a renewed interest in fungal susceptibility testing. We used a previously described disk diffusion method to evaluate the susceptibility profile of a large collection of recent clinical Candida spp. isolates against fluconazole. A total of 1,784 yeast isolates were tested, including the following species: Candida albicans (1,036), C. tropicalis (279), C. parapsilosis (202), C. glabrata (119), C. guilliermondii (90), C. krusei (32), C. lusitaniae (7), Candida spp. (14) and other yeasts (5). Susceptibility ranking to fluconazole obtained with all yeasts tested was: C. parapsilosis congruent with C. tropicalis congruent with C. guilliermondii > C. glabrata > C. krusei. The majority (94) of all yeast isolates tested were susceptible to fluconazole. Isolates of C. glabrata and C. krusei exhibited the highest rate of DDS/resistance among all isolates tested but they represented only 9 of all yeasts routinely sent to our lab. Careful periodical surveillance is needed in order to identify any changes in the susceptibility patterns of fluconazole with the increased use of this antifungal agent in Brazilian tertiary care hospitals.