Species Distribution and Antifungal Susceptibility of Invasive Candidiasis: A 2016-2017 Multicenter Surveillance Study in Beijing, China

Figures & data

Table 1 Species Distribution of 1496 Invasive Candida Isolates Based on Clinical Characteristics

Characteristics	No. of Isolates or Patients
	Total	C. albicans	C. tropicalis	C. glabrata complex^c	C. parapsilosis Complex^d	C. lusitaniae	C. krusei	Other Candida^e
Number of isolates	1496	747	233	221	213	25	22	35
Patient age (years)
0–1	72	27	3	1	29	12	0	0
2–14	37	13	13	1	9	1	0	0
15–49	281	134	60	33	38	5	3	8
50–65	485	261	68	74	58	3	10	11
>65	621	312	89	112	79	4	9	16
Gender
Male	887	412	143	114	169	14	17	18
Female	609	335	90	107	44	11	5	17
Isolation site
Blood	554	218	96	92	119	14	5	10
Ascitic fluid	402	233	63	65	20	2	10	9
Pus	133	70	20	12	26	1	0	4
Bile	120	72	18	12	10	2	4	2
Bronchoalveolar lavage fluid	102	62	12	16	3	4	2	3
Catheter	82	37	11	12	18	1	1	2
Pleural fluid	42	25	6	4	6	0	0	1
Tissue	22	11	0	3	5	1	0	2
Cerebrospinal fluid	15	8	4	0	3	0	0	0
Other specimens^a	24	11	3	5	3	0	0	2
Clinical department
ICU	471	240	85	80	44	8	6	8
Surgery	411	215	52	63	59	2	8	12
Medicine	341	171	58	50	46	3	3	10
Emergency	120	53	20	19	24	0	3	1
Other departments^b	153	68	18	9	40	12	2	4

Notes: ^aIncludes joint fluid, vitreous humor, peritoneal dialysate fluid. ^bIncludes pediatrics, dermatology, gynecology and obstetrics, endocrinology, otorhinolaryngology. ^cIncludes Candida glabrata sensu stricto (215) and Candida nivariensis (6). ^dIncludes Candida parapsilosis sensu stricto (192), Candida metapsilosis (7), Candida orthopsilosis (11) and Lodderomyces elongisporus (3). ^eInclude Candida guilliermondii (13), Candida pelliculosa (4), Candida lipolytica (3), Candida norvegensis (2), Candida kefyr (3), Candida inconspicua (3), Candida haemulonii (2), Candida rugosa (1), Candida stellatoidea (1), Candida famata (1), Candida freyschussii (1), Candida fabianii (1).

Table 2 In vitro Susceptibilities of 1496 Candida Isolates to Six Antifungal Agents as Determined by the Broth Microdilution Method According to the Guidelines of the Clinical and Laboratory Standards Institute

Organism and Agent	MIC (mg/L)^b			% of Isolates in Each Indicated Susceptibility Category by CBP^c				% of Isolates by ECV^d
	Range	50%	90%	S	S-DD	I	R	WT	non-WT
C. albicans (n = 747)
Fluconazole	0.25–64	0.5	2	98	1.7		0.3
Voriconazole	0.008–2	0.016	0.064	97.2		2.5	0.3
Itraconazole	0.016–1	0.125	0.5
Amphotericin B	0.016–2	0.5	1					100	0
5-flucytosine	0.064–128	0.064	0.125
Micafungin	0.008–2	0.064	0.125	99.7		0	0.3
C. tropicalis (n = 233)
Fluconazole	0.125–512	0.5	64	81.5	1.3		17.2
Voriconazole	0.008–32	0.032	2	81.1		3	15.9
Itraconazole	0.016–32	0.25	0.5					96.6	3.4
Amphotericin B	0.25–2	1	1					100	0
5-Flucytosine	0.064–0.125	0.064	0.064
Micafungin	0.008–2	0.032	2	97.9		0.9	1.3
C. glabrata species complex (n = 221)
Fluconazole	0.25–256	8	32		94.1		5.9
Voriconazole	0.016–16	0.125	0.5					82.4	17.6
Itraconazole	0.016–16	0.5	1					96.8	3.2
Amphotericin B	0.008–2	1	1					100	0
5-flucytosine	0.064–8	0.064	0.064
Micafungin	0.008–4	0.032	0.064	91.9		5.9	2.3
C. parapsilosis species complex (n = 213)
Fluconazole	0.25–128	1	2	91.1	4.2		4.7
Voriconazole	0.008–8	0.032	0.125	92		4.7	3.3
Itraconazole	0.016–2	0.25	0.5
Amphotericin B	0.008–2	0.5	1					100	0
5-flucytosine	0.064–64	0.064	0.125
Micafungin	0.008–4	1	2	99.5		0.5	0
C. lusitaniae (n = 25)
Fluconazole	0.25–16	0.5	2					88	12
Voriconazole	0.016–0.25	0.016	0.064
Itraconazole	0.064–0.5	0.25	0.5					100	0
Amphotericin B	0.016–1	0.5	1
5-flucytosine	0.064–2	0.064	0.25
Micafungin	0.008–1	0.25	0.5					92	8
C. krusei (n = 22)
Fluconazole	8–512	16	32
Voriconazole	0.016–4	0.125	0.5	90.9		4.5	4.5
Itraconazole	0.032–2	0.5	0.5					95.5	4.5
Amphotericin B	0.125–2	1	1					100	0
5-flucytosine	0.064–8	2	4
Micafungin	0.008–0.5	0.125	0.5	90.9		9.1
C. guilliermondii (n=13)
Fluconazole	2–64	16	32					46.2	53.8
Voriconazole	0.064–2	0.25	1
Itraconazole	0.064–2	1	2
Amphotericin B	0.25–2	0.75	1
5-flucytosine	0.064–128	0.064	4
Micafungin	0.5–2	1	2	100		0	0
Other Candida species (n = 22)^a
Fluconazole	1–512	8	32
Voriconazole	0.016–16	0.125	0.5
Itraconazole	0.032–32	0.5	1
Amphotericin B	0.25–16	0.5	1
5-flucytosine	0.064–128	0.125	8
Micafungin	0.008–2	0.125	0.5

Notes: ^aIncludes Candida pelliculosa (n = 4), Candida lipolytica (n = 3), Candida norvegensis (n = 2), Candida kefyr (n = 3), Candida inconspicua (n = 3), Candida haemulonii (n = 2), Candida rugosa (n = 1), Candida stellatoidea (n = 1), Candida famata (n = 1), Candida freyschussii (n = 1), Candida fabianii (n = 1). ^b50% and 90%, MICs at which 50% and 90% of isolates are inhibited, respectively. ^cCBP, clinical breakpoint; S, susceptible; I, intermediate; S-DD, susceptible-dose dependent; R, resistant. ^dECV, epidemiological cutoff values; WT, wild-type; non-WT, non-wild-type.

Figure 1 Geographic variations of C. albicans, C. tropicalis, C. glabrata complex, C. parapsilosis complex and other Candida species at 37 surveillance sites.

Abbreviations: MT, China Meitan General Hospital; DZ, Dongzhimen Hospital of Beijing University of Chinese Medicine; YZ, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital; PG, Beijing Pinggu Hospital; BZ, Peking University Cancer Hospital and Institute; DF, Dongfang Hospital of Beijing University of Chinese Medicine; BJ5, Peking University Third Hospital; FT, Beijing Fengtai Hospital; BJ7, The 8th Medical Center of Chinese PLA General Hospital; DL, Beijing Electric Power Hospital; CP, Beijing Changping Hospital; TR, Beijing Tongren Hospital; XH, Peking Union Medical College Hospital; TH, Beijing Tsinghua Changgung hospital; GH, Chinese PLA General Hospital; CY, Beijing Chaoyang Hospital; FW, Fuwai hospital; HR, Beijing Huairou Hospital; LH, Beijing Luhe Hospital; YA, You’an Hospital; J1, The Fourth Medical Center of the Chinese PLA General Hospital; J2, The Fifth Medical Center of Chinese PLA General Hospital; BJ, Beijing Hospital; HT, Aerospace Center Hospital; JZ, The Seventh Medical Center of PLA General Hospital; FX, Fuxing Hospital; AZ, Anzhen Hospital; JM, Beijing Jingmei Group General Hospital; XW, Xuanwu Hospital; YD, Hebei Yanda Hospital; RT, Children’s Hospital, Capital Institute of Pediatrics; DT, Beijing Ditan Hospital; SG, Peking University Shougang Hospital; TT, Beijing Tiantan Hospital; FC, Beijing Gynecology and Obstetrics Hospital; W2, Beijing Armed Police Corps Second Hospital; BJ1, Beijing Chaoyang Hospital (West).