Candida species are the most common cause of fungal infections in hospitalized patients. Recent studies have reported a relative reduction in the rates of infection caused by
Candida albicans and a ...shift toward non-
albicans Candida spp. Data on the distribution and susceptibility of
Candida spp. from children's hospitals are limited.
Clinical isolates of
Candida were collected from 4 US children's hospitals in 2003. Broth dilution MICs for amphotericin B, fluconazole, voriconazole, caspofungin, posaconazole, and ravuconazole were performed according to National Committee for Clinical Laboratory Standards-approved methodology. A total of 179 clinical isolates were identified and included. Of 179, 77 (43%) were
C. albicans.
Candida parapsilosis isolates were the second most frequently identified (57/175, 32%), followed by
Candida glabrata,
Candida tropicalis, and
Candida lusitaniae (approximately 8% each). Caspofungin was the most active agent in vitro against all
Candida spp. Fluconazole resistance was seen among
C. glabrata,
C. tropicalis, and
Candida krusei isolates. Newer azoles had improved activity against fluconazole-resistant isolates of
Candida. Among isolates of
C. parapsilosis, nearly 20% were resistant to amphotericin B. The current study highlights the emergence of
C. parapsilosis as a distinct pediatric pathogen with clinical and therapeutic implications. Furthermore, our current susceptibility data include newer antifungal agents that appear to be quite active in vitro and may provide new therapeutic options for the treatment of serious yeast infections in children.
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