title: Antifungal susceptibilities of bloodstream isolates of Candida species from nine hospitals in Korea: application of new antifungal breakpoints and relationship to antifungal usage.
abstract: We applied the new clinical breakpoints (CBPs) of the Clinical and Laboratory Standards Institute (CLSI) to a multicenter study to determine the antifungal susceptibility of bloodstream infection (BSI) isolates of Candida species in Korea, and determined the relationship between the frequency of antifungal-resistant Candida BSI isolates and antifungal use at hospitals. Four hundred and fifty BSI isolates of Candida species were collected over a 1-year period in 2011 from nine hospitals. The susceptibilities of the isolates to four antifungal agents were determined using the CLSI M27 broth microdilution method. By applying the species-specific CBPs, non-susceptibility to fluconazole was found in 16.4% (70/428) of isolates, comprising 2.6% resistant and 13.8% susceptible-dose dependent isolates. However, non-susceptibility to voriconazole, caspofungin, or micafungin was found in 0% (0/370), 0% (0/437), or 0.5% (2/437) of the Candida BSI isolates, respectively. Of the 450 isolates, 72 (16.0%) showed decreased susceptibility to fluconazole [minimum inhibitory concentration (MIC) ≥4 μg/ml]. The total usage of systemic antifungals varied considerably among the hospitals, ranging from 190.0 to 7.7 defined daily dose per 1,000 patient days, and fluconazole was the most commonly prescribed agent (46.3%). By Spearman's correlation analysis, fluconazole usage did not show a significant correlation with the percentage of fluconazole resistant isolates at hospitals. However, fluconazole usage was significantly correlated with the percentage of fluconazole non-susceptible isolates (r = 0.733; P = 0.025) or the percentage of isolates with decreased susceptibility to fluconazole (MIC ≥4 μg/ml) (r = 0.700; P = 0.036) at hospitals. Our work represents the first South Korean multicenter study demonstrating an association between antifungal use and antifungal resistance among BSI isolates of Candida at hospitals using the new CBPs of the CLSI.
authors.affiliation: Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.
authors.forename: Eun Jeong
authors.initials: EJ
authors.lastname: Won
authors.affiliation: Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.
authors.forename: Jong Hee
authors.initials: JH
authors.lastname: Shin
authors.affiliation: Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.
authors.forename: Min Ji
authors.initials: MJ
authors.lastname: Choi
authors.affiliation: Department of Laboratory Medicine, Ajou University School of Medicine, Suwon, Republic of Korea.
authors.forename: Wee Gyo
authors.initials: WG
authors.lastname: Lee
authors.affiliation: Department of Laboratory Medicine, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea.
authors.forename: Yeon-Joon
authors.initials: YJ
authors.lastname: Park
authors.affiliation: Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
authors.forename: Young
authors.initials: Y
authors.lastname: Uh
authors.affiliation: Department of Laboratory Medicine, Pusan National University Hospital, Busan, Republic of Korea.
authors.forename: Shine-Young
authors.initials: SY
authors.lastname: Kim
authors.affiliation: Department of Laboratory Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
authors.forename: Mi-Kyung
authors.initials: MK
authors.lastname: Lee
authors.affiliation: Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.
authors.forename: Soo Hyun
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.
authors.forename: Myung Geun
authors.initials: MG
authors.lastname: Shin
authors.affiliation: Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.
authors.forename: Soon Pal
authors.initials: SP
authors.lastname: Suh
authors.affiliation: Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.
authors.forename: Dong Wook
authors.initials: DW
authors.lastname: Ryang
mesh_terms: D000935:Antifungal Agents / Q000494:pharmacology*; D002175:Candida / Q000187:drug effects*; D016469:Fungemia / Q000382:microbiology*; D006761:Hospitals; D006801:Humans; D008826:Microbial Sensitivity Tests; D056910:Republic of Korea
chemical_list: D000935:Antifungal Agents