Candidaemia in England, Wales and Northern Ireland: 2010 - Antifungal Susceptibility

Antifungal agents were added to the list of antimicrobial agents in LabBase2 in May 2005. In 2009, 37 of 250 UK laboratories participating in the National External Quality Assessment Service (NEQAS) microbiological testing scheme were routinely undertaking antifungal susceptibility testing [4]. Of the candidaemia reports in LabBase2 received in 2010, 622 of 1,714 (36%) reports provided susceptibility results to one or more of the following agents – amphotericin B, caspofungin, itraconazole, ketoconazole, fluconazole, voriconazole. This is a marked increase on the 91 (of 1,726; 5%) reports tested in 2009.

All reports of Candida ciferrii (1), Candida guilliermondi (9), Candida kefyr (6), and Candida famata (2) tested for antifungal susceptibility indicated sensitivity to the agents tested.  Of the 179 C. glabrata isolates tested, 32/80 (40%) were reported as being resistant or of intermediate resistance to fluconazole (table 3), with three isolates reported as resistant or intermediate to more than one agent (itraconizole, fluconazole and voriconazole). Only one case of C. krusei was tested for anti-fungal susceptibilities, this being resistant to fluconazole and sensitive to voriconazole. Of the pathogenic Candida species, C. glabrata tends to be more resistant to antifungal agents, and C. krusei is intrinsically resistant to fluconazole [5]. The results reported in LabBase2 are consistent with this pattern although should be interpreted with caution owing to the small numbers of reports.

Table 3 Antifungal susceptibility reported for C. albicans, C. glabrata and C. parasilosis blood culture isolates; England, Wales and Northern Ireland: 2010

For advice on treatment of fungal infections or for reference mycology services including species identification and confirmation of sensitivity testing results, laboratories can submit isolates to the Mycology Reference Laboratory in Bristol.

• Introduction
• Overall trend in reports
• Region-specific rates
• Species-specific reports
• Age-specific rates

Last reviewed: 16 September 2011