The incidence of nosocomial Candida
fungemia increased 36-fold from 1981 (0.8/10,000 discharges) to 2000 (28.8/10,000 discharges) at the National Taiwan University Hospital, a 2000-bed teaching hospital in northern Taiwan. To understand the current status of resistance to available
antifungal agents among Candida species causing invasive
infections, the in vitro susceptibilities of 222 isolates (collected from July, 1999-June, 2001) were determined. Among all of the Candida species tested, 6% and 7% were resistant to
fluconazole and
itraconazole, respectively. The MIC90 values of
voriconazole and
amphotericin B were 0.5 and 1 microg/ml, respectively, although some isolates of C. krusei (
amphotericin B and
voriconazole MIC, >64 microg/ml) and C. tropicalis and C. glabrata (
voriconazole MICs, >64 microg/ml) were less susceptible to
voriconazole or
amphotericin B. About one-half of the C. glabrata isolates belonged to susceptible dose-dependent (SDD, 36%) or resistant (12%) categories for
fluconazole and 96% belonged to SDD (56%) or resistant (40%) category for
itraconazole. When compared with
fluconazole susceptibility data of blood Candida isolates recovered from patients treated at the same hospital (NTUH) from two different time periods (January, 1994, to June, 1995, and January, 1997, to June, 1999 described in previous reports), the incidence of increased susceptibility of non-krusei Candida isolates to
fluconazole was evident. This trend of increasing susceptibility for
fluconazole did not correlate to the increasing use of this agent in the hospital. None of the random amplified polymorphic
DNA patterns generated by arbitrarily primed PCR using four random
oligonucleotide primers for 14 isolates, which exhibited
fluconazole MICs of > or = 16 microg/ml, were identical, indicating an absence of clonal dissemination among these isolates in the hospital.