The ARTEMIS Global Antifungal Susceptibility Program (ARTEMIS Program) was initiated in 2001 to provide focused surveillance of the activities of
fluconazole and
voriconazole against Candida spp. isolated from blood and other normally sterile sites. A total of 1,586 episodes of
infection were detected
at 61 international study sites. Overall, 57.7% of the
infections were due to Candida albicans, followed by C. glabrata (14.8%), C. parapsilosis (12.5%), C. tropicalis (9.4%), C. krusei (2.7%), and C. lusitaniae (1.5%). Isolates of C. albicans, C. parapsilosis, and C. tropicalis were all highly susceptible to
fluconazole (for 99% of the isolates the MICs were <or=8 microg/ml). Likewise, 99 to 100% of these species were inhibited by <or=1 microg of
voriconazole per ml.
Voriconazole was also active against C. glabrata (93% of the isolates were susceptible [MICs <or= 1 microg/ml]) and C. krusei (100% of the isolates were susceptible). The
agar-based Etest and disk diffusion methods performed well for the testing of both
fluconazole and
voriconazole compared to the broth microdilution MIC reference method. These observations establish the continued importance of C. albicans as a pathogen and the sustained activity of
fluconazole and the broad spectrum of activity of
voriconazole and will serve as the first-year benchmark for the ARTEMIS Program. Continued surveillance and refinement of broth- and
agar-based test methods will help to identify susceptibility trends and improve the laboratory capability for antifungal susceptibility testing.