International surveillance of blood stream infections due to Candida species in the European SENTRY program: Species distribution and antifungal susceptibility including the investigational triazole and echinocandin agents

The SENTRY Antimicrobial Surveillance Program, an international study of bl ood stream infections (BSIs), defected 170 episodes of candidemia in 20 Eur opean medical centers (13 nations between January and December, 1997. Twent y-three percent of the candidal BSI occurred in patients hospitalized in ni t intensive cave unit, 21% in patients in an internal medicine service, 13% in patients in a surgical service, and 9% in patients in an oncology servi ce. Overall, 53% of the BST were attributable to Candida albicans followed in prevalence by C. parapsilosis (21%), C. glabrata (12%), C. tropicalis (6 %), C. famata 12%), C. krusei (1%), and C. inconspicua (1%). As observed pr eviously in Canada and Latin America, C. parapsilosis and nor C. glabrata, was the most common non-albicans species causing yeast BSI in Europe. The p roportion of these candidemias attributable to C. albicans varied widely fr om 0-100% among the 20 European centers. Among the different species of Can dida, resistance to fluconazole (MIC, greater than or equal to 64 mu g/mL) and itraconazole (MIC, greater than or equal to 1.0 mu g/mL) was observed w ith C. glabrata and C. krusei and was observed more rarely among other spec ies (e.g., C. inconspicua). Isolates of C. albicans, C. parapsilosis, C. tr opicalis, and C. guilliermondii were all highly susceptible to both flucona zole and itraconazole. Furthermore, the investigational triazoles (BMS-2071 47, Sch 56592, and voriconazole and an echinocandin (MK-0991) all demonstra ted potent in vitro activity (MIC(90)s, 0.5, 0.5, 1.0, and 2.0 mu g/mL, res pectively) against these isolates. Continued surveillance at an internation al level will be important to monitor trends in species distribution and an tifungal susceptibility among invasive strains of Candida. (C) 1999 Elsevie r Science Inc.