Key words: Candida, fungemia, antifungal activity, micafungin, fluconazole-resistant

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1 Key words: Candida, fungemia, antifungal activity, micafungin, fluconazole-resistant

2 Fig. 1 Annual changes in percentages of fungi isolated from blood and vascular catheters Fig. 2 Frequencies of fungi isolated from blood and vascular catheters ( )

3 Table 1 Effect of antifungal activity on incubation time of antifungal agents in standard organisms Fig. 3 Comparison of cumulative MICs for 6 antifungal agents between 24 hours of incubation and 48 hours of incubation

4 Table 2 MICs of micafungin (MCFG) for yeast-like organisms Table 3 MICs of amphotericin B (AMPH-B) for yeast-like organisms note: The vertical dashed line shows the MIC breakpoint.

5 Table 4 MICs of fluconazole (FLCZ) for yeast-like organisms Table 5 MICs of itraconazole (ITCZ) for yeast-like organisms note: The vertical dashed line shows the MIC breakpoint.

6 Table 6 MICs of micronazole (MCZ) for yeast-like organisms Table 7 MICs of flucytosine (5-FC) for yeast-like organisms note: The vertical dashed line shows the MIC breakpoint.

7 Table 8 MIC of antifungal agents for fluconazole (FLCZ)-or flucytosine (5-FC)-resistant Candida spp. Table 9 Patient profiles of isolated fluconazole-or flucytosine-resistant strains

8 9) National Committee for Clinical Laboratory Standards: Reference method for broth dilution antifungal susceptibility testing of yeasts; approved standard, NCCLS document M27-A2, National Committee for Clinical Laboratory Standards, Wayne, Pa. 2002; ) Pagano L, Antinori A, Ammassari A, Mele L, Nosari A, Melillo L, et al. Retrospective study of candidemia in patients with hematological malignancies. Clinical features, risk factors and outcome of 76 episodes. Eur J Haematol 1999; 63: ) Launay O, Lortholary O, Bouges-Michel C, Jarrousse B, Bentata M, Guillevin L: Candidemia; 12) Marr KA, Seidel K, Slavin MA, Bowden RA, a nosocomial complication in adults with latestage AIDS. Clin Infect Dis 1998; 26: Sschoch G, Flowers MED, et al.: Prolonged fluconazole prophylaxis is associated with persistent protection against candidiasis-related death 3) Yamazaki T, Kume H, Murase S, Yamashita E, Arisawa M: Epidemiology of visceral mycoses: Analysis of data in annual of the pathologi- in allogeneic marrow transplant recipients, long-term follow-up of a randomized, placebocontrolled trial. Blood 2000; 96: cal autopsy cases in Japan. J Clin Microb 1999; 37: ) Vermes A, Guchelaar HJ, Dankert J: Flucytosine: a review of its pharmacology, clinical indi- 4) Hajieh RA, Sofair AN, Harrison LH, Lyon GM, Arthington-Skaggs BA, Mirza SA, et al. Incidence of bloodstream infections due to Candida cations, pharmacokinetics,toxicity and drug interactions. J Antimicrob Chemother 2000; 46 species and in vitro susceptibilities of isolates collected from 1998 to 2000 in a populationbased active surveillance program. J Clin Micro- biol 2004; 42: ) Perea S, Patterson TF: Antifungal resistance in pathogenic fungi. Clin Infect Dis 2002; ) Dimitrios P.K., Russell E.L.: Antifungal drug resistance og pathogenic fungi. Lancet 2002; 17) Jarvis B, Figgitt DP, Scott LJ: Micafungin. Drugs 2004; 64: :

9 Isolation Rate and Antifungal Drug Susceptibility of Yeast Like Fungi Isolated from Blood or Vascular Catheter Toyoko OGURI 1), Shigeki MISAWA 2), Ayako NAKAMURA 2), Shigemi KONDO 3), Jun IGARr & Takeshi MORI 4) Clinical Laboratory, Juntendo University Nerima 1) Hospital, 2) Clinical Laboratory, Juntendo University Hospital, Clinical Pathology, Juntendo University School 3) of Medicine, 4) Hematology, Juntendo University School of Medicine Increased resistance of strains to antifungal drugs has gained increasing attention. We studied the status of fungal isolation from blood and vascular catheters at Juntendo University Hospital from 1994 to The major fungi isolated were Candida albicans, Candida parapsilosis, Candida glabrata and Candida trophicalis, or 86% yeast-like fungi. Isolation of these fungi from vascular catheters is increasing. The effectiveness of 6 anti-fungal agents against 116 yeast-like fungi was measured by microdilution. In showed the strongest antifungal activity among the drugs tested for above Candida spp.. Five of 37 strains of C. albi- (ITCZ) but MICs of MGFG, flurocytosine (5-FC) and amphotericin B (AMPH-B). Two of 38 strains of C. parapsilosis are tested against AMPH-B. Six patients from whom resistant fungi were isolated from blood and vascular catheters have severe diseases and/or are have just undergone a major surgical operation. These results indicate that it is vital for deep mycosis to start early treatment with appropriate drugs selected based on rapid detection and identification of organisms and the drug susceptibility of organisms.

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