Results from the ARTEMIS DISK Global AntifungalSurveillance Study: a 6.5-Year Analysis of Susceptibilitiesof Candida and Other Yeast Species to Fluconazole andVoriconazole by Standardized Disk Diffusion Testing
Open accessAbstract
Fluconazole in vitro susceptibility test results for 140,767 yeasts were collected from 127 participating investigators in 39 countries from June 1997 through December 2003. Data were collected on 79,343 yeast isolates tested with voriconazole from 2001 through 2003. All investigators tested clinical yeast isolates by the CLSI (formerly NCCLS) M44-A disk diffusion method. Test plates were automatically read and results were recorded with the BIOMIC Vision Image Analysis System. Species, drug, zone diameter, susceptibility category, and quality control results were collected quarterly via e-mail for analysis. Duplicate (the same patient, same species, and same susceptible-resistant biotype profile during any 7-day period) and uncontrolled test results were not analyzed. The 10 most common species of yeasts all showed less resistance to voriconazole than to fluconazole. Candida krusei showed the largest difference, with over 70% resistance to fluconazole and less than 8% to voriconazole. All species of yeasts tested were more susceptible to voriconazole than to fluconazole, assuming proposed interpretive breakpoints of ≥17 mm (susceptible) and≤ 13 mm (resistant) for voriconazole. MICs reported in this study were determined from the zone diameter in millimeters from the continuous agar gradient around each disk, which was calibrated with MICs determined from the standard CLSI M27-A2 broth dilution method by balanced-weight regression analysis. The results from this investigation demonstrate the broad spectrum of the azoles for most of the opportunistic yeast pathogens but also highlight several areas where resistance may be progressing and/or where previously rare species may be“ emerging.”
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Currently, Candida albicans accounts for less than 50% of all Candida bloodstream infections.
“Presently, C albicans accounts for less than 50% of all BSIs caused by the Candida genus.3,[26][27][28][29][30]”
From Fungal Sepsis: Optimizing Antifungal Therapy in the Critical Care Setting (2011) · cites this paper as [26]
Interpretive breakpoints for fluconazole, itraconazole, voriconazole, and flucytosine have been developed by considering data relating MICs to known resistance mechanisms, MIC distribution profiles, pharmacokinetic and pharmacodynamic parameters, and the relationship between in vitro activity and clinical outcomes.
“Interpretive breakpoints for four systemically active antifungal agents (fluconazole, itraconazole, voriconazole, and flucytosine [5FC]) have been developed”
From Epidemiology of Invasive Candidiasis: a Persistent Public Health Problem (2007) · cites this paper as [226]
These CLSI methods are reproducible and accurate and provide clinically useful information comparable to that of antibacterial testing.
“These methods are reproducible and accurate and provide clinically useful information that is comparable to that of antibacterial testing (223, 225, 226, 253).”
From Epidemiology of Invasive Candidiasis: a Persistent Public Health Problem (2007) · cites this paper as [226]
Among 13,338 BSI isolates of Candida (12 species from >200 institutions worldwide) tested by BMD at the University of Iowa between 1992 and 2004, resistance to fluconazole (MIC ≥64 μg/ml) was ≤3% for all species, with the exception of C. glabrata (9%) and C. krusei (40%).
“Among 13,338 BSI isolates of Candida (12 species from > 200 institutions worldwide) tested by BMD at the University of Iowa between 1992 and 2004, resistance to fluconazole (MIC ≥ 64 𝛍 g/ml) was ≤ 3% for all species, with the exception of C. glabrata (9%) and C. krusei (40%) (226).”
From Epidemiology of Invasive Candidiasis: a Persistent Public Health Problem (2007) · cites this paper as [226]
BSI isolates of C. glabrata from all four monitored geographic regions collected between 2001 and 2004 appear to be progressively more resistant to fluconazole.
“glabrata from all four monitored geographic regions collected between 2001 and 2004 appear to be progressively more resistant to fluconazole (226).”
From Epidemiology of Invasive Candidiasis: a Persistent Public Health Problem (2007) · cites this paper as [226]
C. krusei is well known for intrinsic resistance to fluconazole.
“Among the less common species of Candida known to cause IC, C. krusei is well known for its intrinsic resistance to fluconazole (221, 226).”
From Epidemiology of Invasive Candidiasis: a Persistent Public Health Problem (2007) · cites this paper as [226]
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- Authors
- Pfaller, M. A., Diekema, D. J., Rinaldi, M. G., Barnes, R., Hu, B., Veselov, A. V., Tiraboschi, N., Nagy, E., & Gibbs, D. L.
- Affiliations
- University of Iowa (US)
- The University of Texas at San Antonio Health Science Center (US)
- University of Wales (GB)
- Zhongshan Hospital (CN)
- Institute of Antimicrobial Chemotherapy, Smolensk, Russia
- Hospital de Clínicas "José de San Martín" (AR)
- University of Szeged (HU)
- Giles Scientific, Inc., Santa Barbara, California
- Venue
- Journal of Clinical Microbiology
- Publisher
- American Society for Microbiology
- Published
- 2005-12
- Volume
- 43
- Issue
- 12
- Pages
- 5848-5859
- ISSN
- 0095-1137 (ISSN-L)
- 1098-660X
- PMC
- PMC1317207
- OpenAlex
- W2124750674
- Cited by
- 228
- References
- 34
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 6 · 2023: 3 · 2022: 10 · 2021: 5 · 2020: 5 · 2019: 7 · 2018: 8 · 2017: 8 · 2016: 9 · 2015: 10 · 2014: 12 · 2013: 11 · 2012: 8
- FWCI
- 13.43
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Journal of Clinical Microbiology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (acceptedVersion)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion, other-oa)
- Dspace Repository (Marmara Üniversitesi) (submittedVersion)
- IRIS (submittedVersion)
- Dspace Repository (Marmara Üniversitesi) (submittedVersion, other-oa)
- Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, other-oa)
- SERVAL (Université de Lausanne) (submittedVersion)
- Funders
- Pfizer
- University of Alberta
- Universidad de Buenos Aires
- Peking Union Medical College Hospital
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Yeasts and Rust Fungi Studies
- Life Sciences › Agricultural and Biological Sciences › Ecology, Evolution, Behavior and Systematics › Fungal Plant Pathogen Control
- Keywords
- antifungal susceptibility, Candida, yeast, fluconazole, voriconazole, azole resistance, Candida krusei, disk diffusion, interpretive breakpoints
- MeSH terms
- Antifungal Agents, Candida, Humans, Microbial Sensitivity Tests, Population Surveillance, Pyrimidines, Triazoles, Global Health, Yeasts, Fluconazole, Drug Resistance, Fungal, Voriconazole
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