Geographic variation in the susceptibilities of invasive isolates of Candida glabrata to seven systemically active antifungal agents:: A global assessment from the ARTEMIS antifungal surveillance program conducted in 2001 and 2002

We examined the susceptibilities to amphotericin B, flucytosine, fluconazole, posaconazole, ravuconazole, voriconazole, and caspofungin of 601 invasive isolates of Candida glabrata and grouped the isolates by geographic location: North America (331 isolates), Latin America (58 isolates), Europe (135 isolates), and Asia-Pacific (77 isolates). Caspofungin (MIC at which 90% of isolates tested are susceptible [MIC90], 0.12 mug/ml; 100% of strains are susceptible [S] at a MIC of less than or equal to1 mug/ml) and flucytosine (MIC90, 0.12 mug/ml; 99.2% S) were the most active agents in all geographic regions. Fluconazole susceptibility was highest in the Asia-Pacific region (80.5% S, 3.9% resistant [RI) and lowest in North America (64% S, 10.3% R) and Latin America (62.1% S, 3.4% R). The extended-spectrum triazoles were most active in the Asia-Pacific region (90 to 96.1% S) and least active in North America (82.5 to 90.3% S). All 46 isolates that were resistant to fluconazole were susceptible to caspofungin (MIC90, 0.06 mug/ml) and flucytosine (MIC90, 0.12 mug/ml) and exhibited variable cross-resistance to posaconazole, ravuconazole, and voriconazole.