Clinical applicability of antifungal susceptibility testing on non-Candidaalbicans species in hospitalized patients

We assessed the distribution, antifungal susceptibility, and treatment asso ciated with 161 non-Candida albicans isolates recovered from hospitalized p atients over a 6-month period. The three most prevalent species were C. gla brata (100), C. tropicalis (28), and C. krusei (15). Resistance of C. glabr ata to fluconazole and itraconazole were 6% and 17% respectively; 80% of th e fluconazole-resisiant isolates were cross-resistant to itraconazole. Prio r azole exposure significantly reduced azole susceptibility in C. glabrata and also affected its subsequent selection among colonized patients. Only 2 1% of the patients had clinical infections. Patients with fungemia were mor e likely to be treated with amphotericin versus an azole. Overall treatment success was higher in patients treated with amphotericin versus an azole ( 56% vs 31%). Routine susceptibility testing on all Candida species does not appear necessary except where therapy with an azole is being considered to detect resistant isolates or for epidemiologic surveillance purposes. Furt her studies are needed to delineate the relationship between azole MICs and treatment outcomes of invasive candidiasis due to non-C. albicans species. (C) 2001 Elsevier Science Inc. All rights reserved.