In Vitro Activities of Voriconazole, Posaconazole, and Four Licensed Systemic Antifungal Agents against Candida Species Infrequently Isolated from Blood

ABSTRACT We determined the in vitro susceptibilities of 314 strains of Candida spp., representing 13 species rarely isolated from blood, to posaconazole and voriconazole as well as four licensed systemic antifungal agents (amphotericin B, flucytosine, fluconazole, and itraconazole). The organisms included 153 isolates of C. krusei , 67 isolates of C. lusitaniae , 48 isolates of C. guilliermondii , 10 isolates of C. famata , 10 isolates of C. kefyr , 6 isolates of C. pelliculosa , 5 isolates of C. rugosa , 4 isolates of C. lipolytica , 3 isolates of C. dubliniensis , 3 isolates of C. inconspicua , 2 isolates of C. sake , and 1 isolate each of C. lambica , C. norvegensis , and C. zeylanoides . MIC determinations were made by the National Committee for Clinical Laboratory Standards reference broth microdilution method and Etest (amphotericin B). Resistance to both amphotericin B and fluconazole was observed in strains of C. krusei , C. lusitaniae , C. guilliermondii , C. inconspicua , and C. sake . Resistance to amphotericin B, but not to fluconazole, was also observed among isolates of C. kefyr and C. rugosa . Posaconazole and voriconazole were active (MIC, ≤1 μg/ml) against 94 to 100% of these isolates. In contrast to the more common species of Candida causing bloodstream infection, these rare species appear to be less susceptible to the currently licensed systemic antifungal agents, with the exception of voriconazole. Continued surveillance will be necessary to detect the emergence of these species as more prevalent, resistant pathogens. The new triazoles appear to offer acceptable coverage of uncommon Candida sp. bloodstream infections.