title: The European Confederation of Medical Mycology (ECMM) survey of candidaemia in Italy: antifungal susceptibility patterns of 261 non-albicans Candida isolates from blood.
abstract: 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.
authors.affiliation: 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
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Tortorano
authors.forename: Anna Lisa
authors.initials: AL
authors.lastname: Rigoni
authors.forename: Emanuela
authors.initials: E
authors.lastname: Biraghi
authors.forename: Anna
authors.initials: A
authors.lastname: Prigitano
authors.forename: Maria Anna
authors.initials: MA
authors.lastname: Viviani
mesh_terms: 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*