The European Confederation of Medical Mycology (ECMM) survey of candidaemia in Italy: antifungal susceptibility patterns of 261 non-albicans Candida isolates from blood.
OBJECTIVE
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.
Tortorano
Anna Maria
AM
Istituto di Igiene e Medicina Preventiva, Università degli Studi-IRCCS Ospedale Maggiore di Milano, via F Sforza 35, 20122 Milano, Italy. annamaria.tortorano@unimi.it
Rigoni
Anna Lisa
AL
Biraghi
Emanuela
E
Prigitano
Anna
A
Viviani
Maria Anna
MA
D002175:Candida; D041022:Candida tropicalis / Q000187:drug effects* / Q000302:isolation & purification*; D002177:Candidiasis / Q000097:blood / Q000453:epidemiology*; D025141:Drug Resistance, Fungal / Q000502:physiology*; D005060:Europe / Q000453:epidemiology; D016469:Fungemia / Q000097:blood / Q000453:epidemiology*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods*