Results from the ARTEMIS DISK Global Antifungal Surveillance Study: a 6.5-Year Analysis of Susceptibilities of Candida and Other Yeast Species to Fluconazole and Voriconazole by Standardized Disk Diffusion Testing

• Published in: Journal of Clinical Microbiology Vol. 43; no. 12; pp. 5848 - 5859
• Main Authors: Pfaller, M. A, Diekema, D. J, Rinaldi, M. G, Barnes, R, Hu, B, Veselov, A. V, Tiraboschi, N, Nagy, E, Gibbs, D. L
• Format: Journal Article
• Language: English
• Published: Washington, DC American Society for Microbiology 01.12.2005
• Subjects: Antifungal Agents - pharmacology; Candida; Candida - classification; Candida - drug effects; Candida krusei; Drug Resistance, Fungal; Fluconazole - pharmacology; Global Health; Humans; Microbial Sensitivity Tests - methods; Mycology; Population Surveillance; Pyrimidines - pharmacology; Triazoles - pharmacology; Voriconazole; Yeasts - classification; Yeasts - drug effects
• ISSN: 0095-1137; 1098-660X; 1098-5530
• DOI: 10.1128/JCM.43.12.5848-5859.2005

Fluconazolein vitro susceptibility test results for 140,767 yeasts were collectedfrom 127 participating investigators in 39 countries from June 1997through December 2003. Data were collected on 79,343 yeast isolatestested with voriconazole from 2001 through 2003. All investigatorstested clinical yeast isolates by the CLSI (formerly NCCLS) M44-A diskdiffusion method. Test plates were automatically read and results wererecorded with the BIOMIC Vision Image Analysis System. Species, drug,zone diameter, susceptibility category, and quality control resultswere collected quarterly via e-mail for analysis. Duplicate (the samepatient, same species, and same susceptible-resistant biotype profileduring any 7-day period) and uncontrolled test results were notanalyzed. The 10 most common species of yeasts all showed lessresistance to voriconazole than to fluconazole. Candida kruseishowed the largest difference, with over 70% resistance to fluconazoleand less than 8% to voriconazole. All species of yeasts tested weremore susceptible to voriconazole than to fluconazole, assuming proposedinterpretive breakpoints of [>/=]17 mm (susceptible) and</=13 mm (resistant) for voriconazole. MICs reported in thisstudy were determined from the zone diameter in millimeters from thecontinuous agar gradient around each disk, which was calibrated withMICs determined from the standard CLSI M27-A2 broth dilution method bybalanced-weight regression analysis. The results from thisinvestigation demonstrate the broad spectrum of the azoles for most ofthe opportunistic yeast pathogens but also highlight several areaswhere resistance may be progressing and/or where previously rarespecies may be"emerging."