Antifungal susceptibility of invasive Candida bloodstream isolates from the Asia-Pacific region

Med Mycol. 2016 Jul 1;54(5):471-7. doi: 10.1093/mmy/myv114. Epub 2016 Feb 11.


Bloodstream infections caused by Candida species are of increasing importance and associated with significant mortality. We performed a multi-centre prospective observational study to identify the species and antifungal susceptibilities of invasive bloodstream isolates of Candida species in the Asia-Pacific region. The study was carried out over a two year period, involving 13 centers from Brunei, Philippines, Singapore, South Korea, Taiwan, Thailand, and Vietnam. Identification of Candida species was performed at each study center, and reconfirmed at a central laboratory. Susceptibility testing was performed using a commercial broth dilution panel (Sensititre YeastOne YST-010, Thermofisher, United Kingdom) with susceptibility categorisation (S = susceptible, S-DD = susceptible dose-dependent) applied using breakpoints from the Clinical Laboratory Standards Institute. Eight hundred and sixty-one Candida isolates were included in the study. The most common species were C. albicans (35.9%), C. tropicalis (30.7%), C. parapsilosis (15.7%), and C. glabrata (13.6%). Non-albicans species exceeded C. albicans species in centers from all countries except Taiwan. Fluconazole susceptibility was almost universal for C. albicans (S = 99.7%) but lower for C. tropicalis (S = 75.8%, S-DD = 6.1%), C. glabrata (S-DD = 94.9%), and C. parapsilosis (S = 94.8%). Echinocandins demonstrated high rates of in vitro susceptibility (S>99%) against C. albicans, C. tropicalis, and C. parapsilosis This study demonstrates that non-albicans species are the most common isolates from bloodstream infections in most countries in the Asia-Pacific region, with C. tropicalis as the predominant species. Because of the prevalence of reduced susceptibility to fluconazole in non-albicans species, the study indicates that echinocandins should be the antifungal of choice in clinically unstable or high-risk patients with documented candidemia.

Keywords: fluconazole, susceptibility testing, echinocandin, antifungal resistance; microbiology, candidemia.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Antifungal Agents / pharmacology*
  • Asia, Southeastern / epidemiology
  • Candida / classification*
  • Candida / drug effects*
  • Candida / isolation & purification
  • Candidemia / epidemiology
  • Candidemia / microbiology*
  • Humans
  • Microbial Sensitivity Tests
  • Prevalence
  • Prospective Studies


  • Antifungal Agents