title: Candida guilliermondii, an opportunistic fungal pathogen with decreased susceptibility to fluconazole: geographic and temporal trends from the ARTEMIS DISK antifungal surveillance program.
abstract: Although a rare cause of invasive candidiasis, Candida guilliermondii has been reported to exhibit decreased susceptibility to antifungal agents. Aside from case reports and small surveys, there is little information regarding the epidemiology and antifungal susceptibility profile of C. guilliermondii. We report geographic and temporal trends in the isolation and antifungal susceptibilities of 1,029 C. guilliermondii clinical isolates collected from 127 medical centers as part of the ARTEMIS DISK Antifungal Surveillance Program. In addition, we report the in vitro susceptibility of 132 bloodstream isolates of C. guilliermondii to caspofungin. C. guilliermondii represented 1.4% of the 75,761 isolates collected from 2001 to 2003 and was most common among isolates from Latin America (3.7% versus 0.6 to 1.1%). Decreased susceptibility to fluconazole was noted (75% susceptible; range, 68 to 77% across regions), and voriconazole was more active in vitro against C. guilliermondii than fluconazole (91% susceptible; range, 88 to 93% across regions). Fluconazole was least active against isolates from dermatology (58%) and surgical (69%) services and against isolates associated with skin and soft tissue infection (68%, compared to 85% susceptible for bloodstream isolates). There was no evidence of increasing azole resistance over time among C. guilliermondii isolates tested from 2001 to 2003. Of 132 bloodstream isolates of C. guilliermondii tested against caspofungin, most were inhibited by < or =2 microg/ml (96%; MIC50/MIC90, 0.5/1.0 microg/ml). C. guilliermondii, a species that exhibits reduced susceptibility to fluconazole, is the sixth most frequently isolated Candida species from this large survey and may be an emerging pathogen in Latin America.
authors.affiliation: Medical Microbiology Division, C606 GH, Department of Pathology, University of Iowa College of Medicine, Iowa City, IA 52242, USA. michael-pfaller@uiowa.edu
authors.forename: M A
authors.initials: MA
authors.lastname: Pfaller
authors.forename: D J
authors.initials: DJ
authors.lastname: Diekema
authors.forename: M
authors.initials: M
authors.lastname: Mendez
authors.forename: C
authors.initials: C
authors.lastname: Kibbler
authors.forename: P
authors.initials: P
authors.lastname: Erzsebet
authors.forename: S-C
authors.initials: SC
authors.lastname: Chang
authors.forename: D L
authors.initials: DL
authors.lastname: Gibbs
authors.forename: V A
authors.initials: VA
authors.lastname: Newell
mesh_terms: D002175:Candida / Q000145:classification* / Q000187:drug effects*; D002177:Candidiasis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D000077336:Caspofungin; D025141:Drug Resistance, Fungal; D054714:Echinocandins; D015725:Fluconazole / Q000494:pharmacology*; D014943:Global Health; D006801:Humans; D055666:Lipopeptides; D010456:Peptides, Cyclic / Q000494:pharmacology; D011159:Population Surveillance; D011743:Pyrimidines / Q000494:pharmacology; D014230:Triazoles / Q000494:pharmacology; D065819:Voriconazole
chemical_list: D054714:Echinocandins; D055666:Lipopeptides; D010456:Peptides, Cyclic; D011743:Pyrimidines; D014230:Triazoles; D015725:Fluconazole; D000077336:Caspofungin; D065819:Voriconazole