Geographic variation in the frequency of isolation and fluconazole and voriconazole susceptibilities of Candida glabrata: an assessment from the ARTEMIS DISK Global Antifungal Surveillance Program
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Geographic differences in frequency and azole resistance among Candida glabrata may impact empiric antifungal therapy choice. We examined geographic variation in isolation and azole susceptibility of C. glabrata. We examined 23 305 clinical isolates of C. glabrata during ARTEMIS DISK global surveillance. Susceptibility testing to fluconazole and voriconazole was assessed by disk diffusion, and the results were grouped by geographic location: North America (NA) (2470 isolates), Latin America (LA) (2039), Europe (EU) (12 439), Africa and the Middle East (AME) (728), and Asia-Pacific (AP) (5629). Overall, C. glabrata accounted for 11.6% of 201 653 isolates of Candida and varied as a proportion of all Candida isolated from 7.4% in LA to 21.1% in NA. Decreased susceptibility (S) to fluconazole was observed in all geographic regions and ranged from 62.8% in AME to 76.7% in LA. Variation in fluconazole susceptibility was observed within each region: AP (range, 50-100% S), AME (48-86.9%), EU (44.8-88%), LA (43-92%), and NA (74.5-91.6%). Voriconazole was more active than fluconazole (range, 82.3-84.2% S) with similar regional variation. Among 22 sentinel sites participating in ARTEMIS from 2001 through 2007 (84 140 total isolates, 8163 C. glabrata), the frequency of C. glabrata isolation increased in 14 sites and the frequency of fluconazole resistance (R) increased in 11 sites over the 7-year period of study. The sites with the highest cumulative rates of fluconazole R were in Poland (22% R), the Czech Republic (27% R), Venezuela (27% R), and Greece (33% R). C. glabrata was most often isolated from blood, normally sterile body fluids and urine. There is substantial geographic and institutional variation in both frequency of isolation and azole resistance among C. glabrata. Prompt species identification and fluconazole susceptibility testing are necessary to optimize therapy for invasive candidiasis.
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Candida glabrata has intrinsic resistance to azole antifungals.
“This could partially be attributed to C. glabrata's intrinsic and acquired resistance to commonly used azole antifungals (Fidel, Vazquez and Sobel 1999; Pfaller and Diekema 2007; Pfaller et al. 2010; Diekema et al. 2012).”
From <i>Candida glabrata</i> : new tools and technologies—expanding the toolkit (2015) · cites this paper as Pfaller et al. 2010
Candida glabrata has commonly acquired resistance to azole antifungals.
“This could partially be attributed to C. glabrata's intrinsic and acquired resistance to commonly used azole antifungals (Fidel, Vazquez and Sobel 1999; Pfaller and Diekema 2007; Pfaller et al. 2010; Diekema et al. 2012).”
From <i>Candida glabrata</i> : new tools and technologies—expanding the toolkit (2015) · cites this paper as Pfaller et al. 2010
C. glabrata has become an important pathogen in North America, Europe (with the exception of Spain), and Australia, whereas C. parapsilosis is the dominant non-albicans species in South America, Japan, and Spain.
“Specifically, C. glabrata has become an important pathogen in North America, Europe (with the exception of Spain), and Australia, whereas C. parapsilosis is the dominant non-albicans species in South America, Japan, and Spain [8,9,10].”
From Treatment of Invasive Candidiasis: A Narrative Review (2018) · cites this paper as [8]
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References 81 · Cited by 80
- Authors
- Pfaller, M. A., Diekema, D. J., Gibbs, D. L., Newell, V. A., Barton, R., Bijie, H., Bille, J., Chang, S.-C., da Luz Martins, M., Duse, A., Dzierzanowska, D., Ellis, D., Finquelievich, J., Gould, I., Gur, D., Hoosen, A., Lee, K., Mallatova, N., Mallie, M., Peng, N. K., Petrikos, G., Santiago, A., Trupl, J., VanDen Abeele, A. M., Wadula, J., & Zaidi, M.
- Affiliations
- University of Iowa (US)
- Leeds General Infirmary (GB)
- National Taiwan University Hospital (TW)
- University of the Witwatersrand (ZA)
- Children's Memorial Health Institute (PL)
- Women's and Children's Hospital (AU)
- Aberdeen Royal Infirmary (GB)
- Dr George Mukhari Hospital (ZA)
- Yonsei University (KR)
- University of Malaya (MY)
- Hospital Clínico Universitario de Caracas (VE)
- Slovak National Museum (SK)
- Chris Hani Baragwanath Hospital (ZA)
- Hospital Zambrano Hellion (MX)
- Corresponding author
- Pfaller, Michael A.
- ORCID
- Venue
- Diagnostic Microbiology and Infectious Disease
- Publisher
- Elsevier BV
- Published
- 2010-06
- Volume
- 67
- Issue
- 2
- Pages
- 162-171
- ISSN
- 0732-8893 (ISSN-L)
- OpenAlex
- W2105891919
- Cited by
- 80
- References
- 81
- Citations by year
- 2026: 4 · 2025: 1 · 2024: 1 · 2023: 2 · 2021: 2 · 2020: 1 · 2019: 3 · 2018: 3 · 2017: 3 · 2016: 5 · 2015: 6 · 2014: 11 · 2013: 8 · 2012: 11
- FWCI
- 7.88
- Type
- journal article
- Language
- en
- Open access
- Licence
- cc-by-nc-nd
- www.elsevier.com/tdm/userlicense/1.0/ (tdm)
- Locations
- Diagnostic Microbiology and Infectious Disease (publishedVersion)
- PubMed (publishedVersion)
- YUHSpace (Yonsei University Medical Library) (submittedVersion, cc-by-nc-nd)
- IRIS (submittedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- SERVAL (Université de Lausanne) (submittedVersion)
- Funders
- Pfizer
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Life Sciences › Agricultural and Biological Sciences › Ecology, Evolution, Behavior and Systematics › Fungal Plant Pathogen Control
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Yeasts and Rust Fungi Studies
- Keywords
- Candida glabrata, regional variation, fluconazole resistance, azole resistance, antifungal susceptibility, Candida species distribution, bloodstream candidiasis, invasive candidiasis, empirical antifungal therapy, clinical isolates, Europe, Latin America, Asia-Pacific region, North America, sentinel sites
- MeSH terms
- Africa, Americas, Antifungal Agents, Asia, Candidiasis, Europe, Geography, Humans, Microbial Sensitivity Tests, Middle East, Pyrimidines, Triazoles, Fluconazole, Drug Resistance, Fungal, Candida glabrata, Voriconazole
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