title: National epidemiology of mycoses survey: a multicenter study of strain variation and antifungal susceptibility among isolates of Candida species.
abstract: The National Epidemiology of Mycoses Survey (NEMIS) involves six academic centers studying fungal infections in surgical and neonatal intensive care unit (ICU) patients. We studied variation in species and strain distribution and anti-fungal susceptibility of 408 isolates of Candida spp. Candida spp. were isolated from blood, other normally sterile site cultures, abscesses, wounds, catheters, and tissue biopsies of 141 patients hospitalized in the surgical (107 patients) and neonatal (34 patients) ICUs of medical centers located in Oregon, Iowa, California, Texas, Georgia, and New York. Isolates were also obtained from selected colonized patients (16 patients) and the hands of health care workers (27 individuals). DNA typing was performed using pulsed field gel electrophoresis, and antifungal susceptibility to amphotericin B, 5-fluorocytosine, fluconazole, and itraconazole was determined using National Committee for Clinical Laboratory Standards (NCCLS) methods. Important variation in susceptibility to itraconazole and fluconazole was noted: MICs of itraconazole ranged from 0.25 microgram/mL (MIC90) in Texas to 2.0 micrograms/mL (MIC90) in New York. Similarly, the MIC90 for fluconazole was higher for isolates from New York (64 micrograms/mL) compared to the other sites (8-16 micrograms/mL). In general, DNA typing revealed patient-unique strains; however, there were 13 instances of possible cross-infection noted in 5 of the medical centers. Notably, 9 of the 13 clusters involved species of Candida other than C. albicans. Potential transmission from patient-to-patient (C. albicans, C. glabrata, C. tropicalis, C. parapsilosis) and health care worker-to-patient (C. albicans, C. parapsilosis, C. krusei) was noted in both surgical ICU and neonatal ICU settings. These data provide further insight into the epidemiology of nosocomial candidiasis in the ICU setting.
authors.affiliation: University of Iowa College of Medicine, Department of Pathology, Iowa City 52242, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Pfaller
authors.forename: S A
authors.initials: SA
authors.lastname: Messer
authors.forename: A
authors.initials: A
authors.lastname: Houston
authors.forename: M S
authors.initials: MS
authors.lastname: Rangel-Frausto
authors.forename: T
authors.initials: T
authors.lastname: Wiblin
authors.forename: H M
authors.initials: HM
authors.lastname: Blumberg
authors.forename: J E
authors.initials: JE
authors.lastname: Edwards
authors.forename: W
authors.initials: W
authors.lastname: Jarvis
authors.forename: M A
authors.initials: MA
authors.lastname: Martin
authors.forename: H C
authors.initials: HC
authors.lastname: Neu
authors.forename: L
authors.initials: L
authors.lastname: Saiman
authors.forename: J E
authors.initials: JE
authors.lastname: Patterson
authors.forename: J C
authors.initials: JC
authors.lastname: Dibb
authors.forename: C M
authors.initials: CM
authors.lastname: Roldan
authors.forename: M G
authors.initials: MG
authors.lastname: Rinaldi
authors.forename: R P
authors.initials: RP
authors.lastname: Wenzel
mesh_terms: D000666:Amphotericin B / Q000494:pharmacology; D000935:Antifungal Agents / Q000494:pharmacology*; D002175:Candida / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D002177:Candidiasis / Q000453:epidemiology*; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004352:Drug Resistance, Microbial; D015725:Fluconazole / Q000494:pharmacology; D006306:Health Surveys; D006801:Humans; D007362:Intensive Care Units; D017964:Itraconazole / Q000494:pharmacology; D008826:Microbial Sensitivity Tests
chemical_list: D000935:Antifungal Agents; D017964:Itraconazole; D000666:Amphotericin B; D015725:Fluconazole