Bloodstream infections due to Candida species: SENTRY Antimicrobial Surveillance Program in North America and Latin America, 1997-1998

An international program of surveillance of bloodstream infections (BSI) in the United States, Canada, and Latin America detected 306 episodes of cand idemia in 34 medical centers (22 in the United States, 6 in Canada, and 6 i n Latin America) in 1997 and 328 episodes in 34 medical centers (22 in the United States, 5 in Canada, and 7 in Latin America) in 1998, Of the 634 BSI , 54.3% were due to Candida albicans, 16.4% were due to C. glabrata, 14.9% were due to C. parapsilosis, 8.2% were due to C. tropicalis, 1.6% were due to C. krusei, and 4.6% were due to other Candida spp. The percentage of BSI due to C albicans decreased very slightly in the United States between 199 7 and 1998 (56.2 to 54.4%; P = 0.68) and increased in both Canada (52.6 to 70.1%; P = 0.05) and Latin America (40.5 to 44.6%; P = 0.67). C. glabrata w as the second most common species observed overall, and the percentage of B SI due to C. glabrata increased in all three geographic areas between 1997 and 1998. C, parapsilosis was the third most prevalent BSI isolate in both Canada and Latin America, accounting for 7.0 and 18.5% of BSI, respectively . 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 infre quently in both 1997 (2.3 and 85%, respectively) and 1998 (1.5 and 7.6%, re spectively). Among the different species of Candida, resistance to fluconaz ole and itraconazole was observed in C. glabrata and C. krusei, whereas iso lates of C. albicans, C. parapsilosis, and C. tropicalis were all highly su sceptible to both fluconazole (98.9 to 100% susceptible) and itraconazole ( 96.4 to 100% susceptible). Isolates from Canada and Latin America were gene rally more susceptible to both triazoles than U.S. isolates were. Continued surveillance appears necessary to detect these important changes.