title: Invasive candidiasis in intensive care units in China: in vitro antifungal susceptibility in the China-SCAN study.
abstract: OBJECTIVE
  The objectives of this study were to determine species distribution and in vitro antifungal susceptibility of Candida isolates identified in the multicentre China-SCAN study of invasive Candida infection (ICI) in intensive care units (ICUs) across China.
  
  
  METHODS
  Candida isolates from patients in the China-SCAN study with documented ICI were evaluated by a central laboratory. Species were identified using chromogenic culture media or the API 20C AUX kit. Susceptibility to fluconazole, voriconazole, itraconazole, caspofungin and amphotericin B was determined using the CLSI broth microdilution method (M27-A3) and updated clinical breakpoints or epidemiological cut-off values.
  
  
  RESULTS
  A total of 389 isolates from 244 patients were analysed. Species identified most frequently were Candida albicans (40.1%), Candida parapsilosis (21.3%), Candida tropicalis (17.2%) and Candida glabrata (12.9%). Rarer species such as Lodderomyces elongisporus and Candida ernobii were also identified. Fluconazole susceptibility was evident in 85.9% (134/156) of C. albicans, 62.7% (42/67) of C. tropicalis and 48.2% (40/83) of C. parapsilosis isolates. Susceptibility to voriconazole was ≥ 90% among all species. All isolates were susceptible to amphotericin B and caspofungin except C. glabrata [86.0% (43/50) susceptible to caspofungin]. Cross-resistance between fluconazole and voriconazole was observed for C. parapsilosis and C. glabrata.
  
  
  CONCLUSIONS
  Although C. albicans was the predominant single species, non-albicans species constituted >50% of isolates. Fluconazole susceptibility was lower in most non-albicans species, indicating that fluconazole resistance should be closely monitored. Susceptibility to voriconazole, amphotericin B and caspofungin is encouraging. Differences between these data and those from other regions emphasize the importance of assessing regional variations.
authors.affiliation: Peking University First Hospital, Research Center for Medical Mycology, Peking University, Beijing, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Liu
authors.forename: Jingwen
authors.initials: J
authors.lastname: Tan
authors.forename: Jimei
authors.initials: J
authors.lastname: Sun
authors.forename: Zhijiang
authors.initials: Z
authors.lastname: Xu
authors.forename: Min
authors.initials: M
authors.lastname: Li
authors.forename: Qing
authors.initials: Q
authors.lastname: Yang
authors.forename: Haifeng
authors.initials: H
authors.lastname: Shao
authors.forename: Liyan
authors.initials: L
authors.lastname: Zhang
authors.forename: Weixia
authors.initials: W
authors.lastname: Liu
authors.forename: Zhe
authors.initials: Z
authors.lastname: Wan
authors.forename: Wei
authors.initials: W
authors.lastname: Cui
authors.forename: Bin
authors.initials: B
authors.lastname: Zang
authors.forename: Dongpo
authors.initials: D
authors.lastname: Jiang
authors.forename: Qiang
authors.initials: Q
authors.lastname: Fang
authors.forename: Bingyu
authors.initials: B
authors.lastname: Qin
authors.forename: Tiehe
authors.initials: T
authors.lastname: Qin
authors.forename: Weiqin
authors.initials: W
authors.lastname: Li
authors.forename: Fengmei
authors.initials: F
authors.lastname: Guo
authors.forename: Dawei
authors.initials: D
authors.lastname: Liu
authors.forename: Xiandong
authors.initials: X
authors.lastname: Guan
authors.forename: Kaijiang
authors.initials: K
authors.lastname: Yu
authors.forename: Haibo
authors.initials: H
authors.lastname: Qiu
authors.forename: Ruoyu
authors.initials: R
authors.lastname: Li
mesh_terms: D000935:Antifungal Agents / Q000494:pharmacology*; D002175:Candida / Q000145:classification* / Q000187:drug effects* / Q000302:isolation & purification; D058365:Candidiasis, Invasive / Q000453:epidemiology* / Q000382:microbiology; D002681:China / Q000453:epidemiology; D006801:Humans; D007362:Intensive Care Units; D008826:Microbial Sensitivity Tests; D016533:Mycological Typing Techniques
chemical_list: D000935:Antifungal Agents
keywords: Candida; albicans; azoles; non-albicans; resistance