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 blood stream infections (BSIs), defected 170 episodes of candidemia in 20 European medical centers (13 nations between January and December, 1997. Twenty-three percent of the candidal BSI occurred in patients hospitalized in nit 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 service. 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 previously in Canada and Latin America, C. parapsilosis and nor C. glabrata, was the most common non-albicans species causing yeast BSI in Europe. The proportion of these candidemias attributable to C. albicans varied widely from 0-100% among the 20 European centers. Among the different species of Candida, 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 with C. glabrata and C. krusei and was observed more rarely among other species (e.g., C. inconspicua). Isolates of C. albicans, C. parapsilosis, C. tropicalis, and C. guilliermondii were all highly susceptible to both fluconazole and itraconazole. Furthermore, the investigational triazoles (BMS-207147, Sch 56592, and voriconazole and an echinocandin (MK-0991) all demonstrated potent in vitro activity (MIC(90)s, 0.5, 0.5, 1.0, and 2.0 mu g/mL, respectively) against these isolates. Continued surveillance at an international level will be important to monitor trends in species distribution and antifungal susceptibility among invasive strains of Candida. (C) 1999 Elsevier Science Inc.