Candida krusei , a Multidrug-Resistant Opportunistic Fungal Pathogen: Geographic and Temporal Trends from the ARTEMIS DISK Antifungal Surveillance Program, 2001 to 2005

Abstract

Candida krusei is well known as a fungal pathogen for patients with hematologic malignancies and for transplant recipients. Using the ARTEMIS Antifungal Surveillance Program database, we describe geographic and temporal trends in the isolation of C. krusei from clinical specimens and the in vitro susceptibilities of 3,448 isolates to voriconazole as determined by CLSI (formerly NCCLS) disk diffusion testing. In addition, we report the in vitro susceptibilities of bloodstream infection isolates of C. krusei to amphotericin B (304 isolates), flucytosine (254 isolates), anidulafungin (121 isolates), caspofungin (300 isolates), and micafungin (102 isolates) as determined by CLSI broth microdilution methods. Geographic differences in isolation were apparent; the highest frequency of isolation was seen for the Czech Republic (7.6%) and the lowest for Indonesia, South Korea, and Thailand (0 to 0.3%). Overall, 83% of isolates were susceptible to voriconazole, ranging from 74.8% in Latin America to 92.3% in North America. C. krusei was most commonly isolated from hematology-oncology services, where only 76.7% of isolates were susceptible to voriconazole. There was no evidence of increasing resistance of C. krusei to voriconazole from 2001 to 2005. Decreased susceptibilities to amphotericin B (MIC at which 90% of isolates were inhibited [MIC 90 ], 4 g/ml) and flucytosine (MIC 90 , 16 g/ml) were noted, whereas 100% of isolates were inhibited by <2 g/ml of anidulafungin (MIC 90 , 0.06 g/ml), micafungin (MIC 90 , 0.12 g/ml) or caspofungin (MIC 90 , 0.25 g/ml). C. krusei is an uncommon but multidrugresistant fungal pathogen. Among the systemically active antifungal agents, the echinocandins appear to be the most active against this important pathogen.

Antifungal activity of medicinal plants from Northeastern Brazil

“…In the past two decades, these species have become significantly more common agents of human infections and the clinical isolates are less sensitive to fluconazole and amphotericin B (Pemán et al, 2004;Barchieesi et al, 2005;Hakki et al, 2006;Li et al, 2007;Pfaller et al, 2008). Overall, the results of the assay for both C. glabrata and C. krusei were promising and may help to develop new strategies against both yeasts which are resistant to fluconazole.…”

Antifungal susceptibility profile of yeast isolates from sterile sites at a tertiary hospital in South Africa

“…C. sake, C. valida and C. inconspicua, were also isolated in low numbers from the blood culture of premature neonates who presented with sepsis, which is consistent with other studies. 11,16,17 The prevalence of fluconazole resistance in non-albicans Candida spp. isolates varies over time in different countries.…”

Citral and carvone chemotypes from the essential oils of Colombian Lippia alba (Mill.) N.E. Brown: composition, cytotoxicity and antifungal activity

“…According to these criteria, in this study, C. krusei was moderately sensitive to the citral chemotype essential oil (GM/MIC 270 µg/mL) and highly sensitive to the commercial monoterpenes, citral (39.72 µg/mL) and R-(+)-citronellal (49.6 µg/mL). This finding is important because C. krusei has been recognised as a potential multidrug-resistant pathogen due to its intrinsic fluconazole resistance and recent reports showing a decreased susceptibility of the pathogen to both flucytosine and amphotericine B (Pfaller et al 2008). Aspergillus fumi-gatus is the main cause of invasive aspergillosis in immunocompromised patients and only a limited number of drugs are available for treatment (Brock et al 2008).…”