title: The relationship between antifungal usage and antifungal susceptibility in clinical isolates of Candida: a multicenter Korean study.
abstract: There have been very few multicenter studies of the relationship between the use of antifungals and resistance to them. We investigated the antifungal susceptibility of 1,301 clinical isolates of Candida collected from nine Korean hospitals during a 3-month period in 2006 to explore the existence of this type of relationship. Antifungal usage in the preceding year, defined as the daily dose per 1,000 patient days (DDD/1,000 PD), was calculated for each hospital. Resistance to fluconazole, itraconazole, and amphotericin B was detected in 2, 9, and 0.2% of the isolates, respectively. The MIC(50)/MIC(90) values were 0.03/0.125 mg/L for voriconazole, 0.06/0.25 mg/l for caspofungin, and 0.03/0.125 mg/l for micafungin. The total usage of systemic antifungals varied considerably among the nine hospitals, ranging from 6.1 to 96.2 DDD/1,000 PD. No relationship was found between the use of fluconazole (MIC> or =64 mg/l) or itraconazole (MIC> or =1 mg/l) and resistance in the Candida species (P>0.05). However, significant correlations were found between the percentage of Candida isolates that were non-susceptible to fluconazole (MIC> or =16 mg/l) and fluconazole usage (r=0.733, P=0.025) or total antifungal usage (r=0.767, P=0.016).
authors.affiliation: Chonnam National University Medical School, Gwangju, Korea.
authors.forename: Soo Hyun
authors.initials: SH
authors.lastname: Kim
authors.forename: Jong Hee
authors.initials: JH
authors.lastname: Shin
authors.forename: Eui-Chong
authors.initials: EC
authors.lastname: Kim
authors.forename: Kyungwon
authors.initials: K
authors.lastname: Lee
authors.forename: Mi-Na
authors.initials: MN
authors.lastname: Kim
authors.forename: Won Gil
authors.initials: WG
authors.lastname: Lee
authors.forename: Young
authors.initials: Y
authors.lastname: Uh
authors.forename: Hye Soo
authors.initials: HS
authors.lastname: Lee
authors.forename: Mi-Kyung
authors.initials: MK
authors.lastname: Lee
authors.forename: Seok Hoon
authors.initials: SH
authors.lastname: Jeong
authors.forename: Sook In
authors.initials: SI
authors.lastname: Jung
authors.forename: Kyung Hwa
authors.initials: KH
authors.lastname: Park
authors.forename: Jin-Sol
authors.initials: JS
authors.lastname: Lee
authors.forename: Myung Geun
authors.initials: MG
authors.lastname: Shin
authors.forename: Soon Pal
authors.initials: SP
authors.lastname: Suh
authors.forename: Dong Wook
authors.initials: DW
authors.lastname: Ryang
mesh_terms: D000666:Amphotericin B / Q000494:pharmacology; D000935:Antifungal Agents / Q000494:pharmacology*; D002175:Candida / Q000187:drug effects* / Q000302:isolation & purification; D002177:Candidiasis / Q000188:drug therapy* / Q000382:microbiology*; D025141:Drug Resistance, Fungal; D004363:Drug Utilization / Q000706:statistics & numerical data*; D015725:Fluconazole / Q000494:pharmacology; D006761:Hospitals; D006801:Humans; D017964:Itraconazole / Q000494:pharmacology; D007723:Korea; D008826:Microbial Sensitivity Tests
chemical_list: D000935:Antifungal Agents; D017964:Itraconazole; D000666:Amphotericin B; D015725:Fluconazole