Antifungal treatment administered in OPAT programs is a safe and effective option in selected patients.

INTRODUCTION: Outpatient parenteral antimicrobial therapy (OPAT) has been recognised as a useful, cost-effective and safe alternative to inpatient treatment. Nevertheless, the most common antimicrobials used are antibiotics, and there is less information about the use of antifungal therapy (AT). The aim of this study is to analyse a cohort of patients treated with AT administered via OPAT and to compare them with patients from the rest of the cohort (RC) treated with antibiotics. METHODS: Prospective observational study with post hoc (or retrospective) analysis of a cohort of patients treated in the OPAT program. We selected the patients treated with antifungals between July 2012 and December 2018. We recorded demographic and clinical data to analyse the validity of the treatment and to compare the differences between the AT and the RC. RESULTS: Of the 1101 patients included in the OPAT program, 24 (2.18%) were treated with AT, 12 Liposomal Amphotericin B, 6 echinocandins and 6 fluconazole. This result is similar to other cohorts. There were differences between the AT vs RC in the number of patients with neoplasia (58.3% vs 28%; p=0.001), IC Charlson>2 (58.3% vs 38.8; p=0.053), duration of treatment (15 days vs 10.39 days; p=0.001) and patients with central catheters (54.2% vs 21.7%; p=0.0001). These differences are justified because there were more hematologic patients included in the AT group. Nevertheless, there were no differences in adverse reactions (25% vs 32.3%; p=0.45) or re-admissions (12.5% vs 10%; p=0.686) and OPAT with AT was successful in 21/24 patients (87.5%). CONCLUSIONS: AT can be successfully administered in OPAT programs in selected patients, that are clinically stable and monitored by an infectious disease physician.

Killing kinetics of anidulafungin, caspofungin and micafungin against Candida parapsilosis species complex: Evaluation of the fungicidal activity.

BACKGROUND: Candida parapsilosis, Candida metapsilosis and Candida orthopsilosis are emerging as relevant causes of candidemia. Moreover, they show differences in their antifungal susceptibility and virulence. The echinocandins are different in terms of in vitro antifungal activity against Candida. Time-kill (TK) curves represent an excellent approach to evaluate the fungicidal activity of antifungal drugs. AIMS: To compare the fungicidal activities of anidulafungin, caspofungin and micafungin against C. parapsilosis species complex by TK curves. METHODS: Antifungal activities of three echinocandins against C. parapsilosis, C. metapsilosis and C. orthopsilosis were studied by TK curves. Drug concentrations assayed were 0.25, 2 and 8µg/ml. CFU/ml were determined at 0, 2, 4, 6, 24 and 48h. RESULTS: Killing activities of echinocandins were species-, isolates- and concentration-dependent. Anidulafungin reached the fungicidad endpoint for 6 out of 7 isolates (86%); it required between 13.34 and 29.67h to reach this endpoint for the three species studied, but more than 48h were needed against one isolate of C. orthopsilosis (8µg/ml). Caspofungin fungicidal endpoint was only achieved with 8µg/ml against one isolate of C. metapsilosis after 30.12h (1 out of 7 isolates; 14%). Micafungin fungicidal endpoint was reached in 12.74-28.38h (8µg/ml) against one isolate each of C. parapsilosis and C. orthopsilosis, and against both C. metapsilosis isolates (4 out of 7 isolates; 57%). CONCLUSIONS: C. metapsilosis was the most susceptible species to echinocandins, followed by C. orthopsilosis and C. parapsilosis. Anidulafungin was the most active echinocandin against C. parapsilosis complex.

Drug susceptibility profile of Candida glabrata clinical isolates from Iran and genetic resistant mechanisms to caspofungin.

BACKGROUND: Candida glabrata is a yeast that can cause hazardous fungal infections with high mortality and drug resistance. AIMS: The aim of this study was to determine the profile of drug susceptibility in clinical isolates of C. glabrata and review the resistance mechanisms to caspofungin. METHODS: A total of 50 C. glabrata clinical isolates from Iran were tested for in vitro susceptibilities to amphotericin B, caspofungin, fluconazole and voriconazole. To investigate the mechanism of resistance to caspofungin, hotspot areas of FKS1 and FKS2 genes were sequenced and gene expression profile was evaluated. RESULTS: All the isolates were susceptible to amphotericin B and caspofungin. Fluconazole resistance was exhibited in four isolates. In addition, only one isolate was resistant to voriconazole. FKS2 with 12 point mutations showed more mutations compared to FKS1 that had only two mutations. All substitutions were synonymous. FKS genes were expressed at comparable levels (no statistical significance) in caspofungin-treated and non-treated cultures. CONCLUSIONS: The silent mutations in the hotspot areas of FKS genes and inconsiderable changes in gene expression were not associated with increased MIC (0.25µg/ml). Other mechanisms of resistance which include mutations outside the hotspot area of FKS genes could be involved in a slight increase of MIC, and they should be identified through complete FKS gene sequencing.

Activador tisular del plasminógeno recombinante para el tratamiento de la vegetación intracardíaca en un lactante de muy bajo peso al nacer / Recombinant tissue plasminogen activator treatment for intracardiac vegetation in a very low birth weight infant

Las nuevas opciones de tratamiento prolongan la hospitalización y aumentan las infecciones intrahospitalarias bacterianas y fúngicas, pero también mejoran la sobrevida de los recién nacidos hospitalizados en la unidad de cuidados intensivos neonatales. Las infecciones fúngicas invasivas en neonatos están asociadas con una morbimortalidad significativa. También pueden diseminarse a órganos específicos y causar endocarditis, endoftalmitis, artritis séptica, nefropatía obstructiva y meningitis. En el caso de la endocarditis, se recomiendan tratamientos antimicóticos sistémicos agresivos y, en algunos casos, la intervención quirúrgica del neonato. Informamos el caso de un lactante prematuro, de bajo peso al nacer, con vegetación intracardíaca. Esta es una complicación rara y potencialmente mortal de infecciones fúngicas invasivas. El paciente recibió tratamiento con caspofungina y un activador tisular del plasminógeno recombinante, en vez de una intervención quirúrgica.

Developing treatment options have resulted in prolonged admission and increased bacterial and fungal nosocomial infections as well as improved survival in neonatal intensive care unit. Invasive fungal infections in newborns are associated with significant morbidity and mortality and can cause endorgan dissemination such as endocarditis, endophthalmitis, septic arthritis, obstructive nephropathy and meningitis. Endocarditis requires aggressive systemic antifungal therapy and sometimes surgical intervention in neonates. We report a low birth weight premature infant with intracardiac vegetation that is rare and a life-threatening complication of invasive fungal infections. He was treated with caspofungin and recombinant tissue plasminogen activator in stead of surgical intervention.

Eficacia y seguridad de la caspofungina en pediatría: revisión sistemática y metaanálisis / Efficacy and safety of caspofungin in children: systematic review and meta-analysis

Las infecciones fúngicas invasivas son una importante causa de morbimortalidad en pediatría. La caspofungina es una equinocandina utilizada como alternativa en la prevención y/o tratamiento de ciertas infecciones fúngicas invasivas en niños, aunque con poca evidencia sobre su eficacia y seguridad en comparación con el tratamiento habitual. Objetivos. Evaluar la eficacia y seguridad de la caspofungina comparada con otros antifúngicos en la prevención y/o tratamiento de infecciones fúngicas invasivas en pediatría. Material y métodos. La estrategia de búsqueda inicial tuvo como objetivo identificar estudios controlados aleatorizados de aceptable calidad metodológica (escala de Jadad > 3) mediante la palabra clave "caspofungin" realizados en pacientes de entre los 0 y los 18 años. Resultados. Solo 3 publicaciones cumplieron los criterios de inclusión. De ellas, 2 fueron en población pediátrica y una en neonatal. No se documentó una mayor incidencia de efectos adversos para la caspofungina y su eficacia no se diferenció de otros antifúngicos (RR típico 1,47; IC 95%: 0,78-2,79). Conclusiones. Esta revisión sistemática sugiere que la caspofungina podría considerarse como una alternativa para su indicación en pediatría en la prevención y tratamiento de las infecciones fúngicas invasivas. Sin embargo, dado el pequeño número de publicaciones existentes, se requieren más estudios para alcanzar conclusiones definitivas.

Invasive fungal infections are a significant cause of morbidity and mortality in children. Caspofungin is an echinocandin used as an alternative treatment in the prevention and/or treatment of certain invasive fungal infections in children, although compared to the standard treatment there is little evidence on its efficacy and safety. Objectives. To evaluate the efficacy and safety of caspofungin compared with other antifungal drugs for the prevention and/or treatment of invasive fungal infections in children. Material and methods. The objective of the initial search strategy was to identify randomized controlled studies of acceptable methodological quality (Jadad scale >3), through the key word "caspofungin", conducted in patients with an age range from 0 to 18 years old. Results. Only 3 publications met the inclusion criteria. Two of them were studies conducted in children and one in newborn infants. A higher incidence of adverse events was not documented for caspofungin and its efficacy was not different from that of other antifungal drugs (typical RR 1.47; CI 95%: 0.78-2.79). Conclusions. This systematic review suggests that caspofungin could be considered as an alternative drug in children for the prevention and treatment of invasive fungal infections. However, given the small number of existing publications, more studies are required to reach definite conclusions.

[First report of invasive fungal disease by Candida fabianii in a non-neonatal paediatric patient]. / Primer caso de infección fúngica invasora por Candida fabianii en un paciente pediátrico no neonatal.

BACKGROUND: Invasive fungal diseases have increased in recent years. Candida species are the most common aetiology. Candida albicans, Candida parapsilosis, Candida tropicalis, Candida glabrata and Candida krusei are the cause of most of them. The aim of this work is to describe the first isolation of Candida fabianii in the blood of a non-neonatal paediatric patient. CASE REPORT: A 2 year-old male with short bowel syndrome, severe malnutrition, and hypophosphataemic rickets deficiency was admitted to paediatric intensive care due to a respiratory tract infection and suspicion of an intestinal pseudo-obstruction. He received several cycles of broad-spectrum antibiotics for several infections due to Pseudomonas aeruginosa and Escherichia coli. After the surgical correction of the intestinal disorder he suffered a new episode of sepsis where yeasts were isolated by culture. The species identification was performed by means of mass spectrometry (MALDI-TOF system, Bruker Daltonic). The identity of the isolate was C.fabianii (anamorph)/Pichia fabianii (teleomorph) with a score of 2.149. Antifungal treatment with caspofungin was prescribed, with good progress of the patient. CONCLUSIONS: Molecular techniques are important for the identification of these species, although mass spectrometry offered a reliable and rapid diagnosis. Treatment with caspofungin was effective.

Voriconazol e caspofungina versus anfotericina B para tratamento de aspergilose em pacientes com neoplasias malignas hematológicas, neutropenia febril ou submetidos a transplante de órgãos / Voriconazole and caspofungin versus amphotericin in the treatment of aspergillosis in high-risk patients: hematologic malignancies, febrile neutropenia or undergoing transplantation in general

A anfotericina B é o antifúngico utilizado no Sistema Único de Saúde (SUS) para o tratamento de infecção fúngica invasiva (IFI). Novos antifúngicos estão sendo selecionados com pouca definição epidemiológica e elevado custo.

Profilaxis antifúngica en niños y adultos sometidos a trasplante de órganos sólidos y de precursores hematopoyéticos / Prophylaxis against fungal infections in solid organ and hematopoietic stem cells transplantation

Invasive fungal infections are an important cause of morbidity and mortality in SOT and HSCT recipients. The main species involved are Candida spp. and Aspergillus spp, less frequently Cryptococcus spp., causal agents of mucormycosis and Fusarium spp. Usually occur within the first six months post-transplant, but they do it later, especially during episodes of rejection, which maintains the state of immune system involvement. Prophylaxis recommendations are specific to each type of transplant. In liver transplantation use of fluconazole is recommended only in selected cases by high risk factor for invasive fungal infections (A1). If the patient has a high risk of aspergillosis, there are some suggestions for adults population to use amphotericin B-deoxycholate, liposomal amphotericin B or caspofungin (C2) without being validated none of these recommendations in pediatric population. In adult lung transplant patients where the risk of aspergillosis is higher than in other locations, we recommend universal prophylaxis with itraconazole 200 mg/day, nebulised liposomal amphotericin B or voriconazole (C2), no validated recommendations for pediatrics. In HSCT, universal prophylaxis is recommended only in allogeneic and autologous selected cases. The most accepted indication is fluconazole (A1), and posaconazole (A1) or micafungin (A1) in selected cases with high risk of aspergillosis.

Las infecciones fúngicas invasoras constituyen una importante causa de morbilidad y mortalidad en los pacientes receptores de TOS y TPH. Los principales agentes involucrados son Candida spp. y Aspergillus spp, menos frecuentemente Cryptococcus spp., agentes causales de mucormicosis y Fusarium spp. Se presentan habitualmente dentro de los primeros seis meses posttrasplante, pero también lo hacen en forma más tardía, especialmente durante episodios de rechazo, en que se mantiene el estado de compromiso del sistema inmune. Existen recomendaciones de proilaxis especíicas para cada tipo de trasplante. En trasplante hepático se recomienda el uso de fluconazol sólo en casos seleccionados por factores de riesgo (A1). Si existe riesgo de asper-gilosis, hay algunas sugerencias en adultos para el uso de anfotericina B-deoxicolato, anfotericina liposomal o caspofungina (todo en categoría C2), sin estar validada ninguna de estas recomendaciones en pediatría. En trasplante pulmonar en paciente adulto, donde el riesgo de aspergilosis es superior a otras localizaciones, se recomienda proilaxis universal, con itraconazol 200 mg/día, anfotericina liposomal nebulizada o voriconazol (C2), sin recomendaciones validadas para pediatría. En TPH, se recomienda proilaxis universal en trasplante alogénico y sólo para casos seleccionados en trasplantes autólogos. La indicación más aceptada es fluconazol (A1), siendo alternativas a evaluar dependiendo del riesgo de aspergilosis, posaconazol (A1) y micafungina (A1).

Susceptibilidad in vitro de candida spp a caspofungina y anfotericina B por los métodos de microdilución en caldo (CLSI), etest y el sistema vitek2. Estudio Comparativo / In vitro susceptibility of candida spp to caspofungin and amphotericin B by broth microdilution methods (CLSI), etest and the vitek2 system. Comparative study

El objetivo de este estudio fue evaluar la susceptibilidad de Candida spp., a caspofungina (CS) y anfotericina B (AMB) por los métodos de microdilución en caldo (CLSI), Etest y sistema automatizado Vitek 2. Se determinó la Concentración Mínima Inhibitoria (CMI) de 208 aislados de Candida spp., obtenidos de pacientes con candidemia, a caspofungina por microdilución en caldo (documento M27-A3 del CLSI) e Etest y a anfotericina B por Etest y Vitek2. Las CMI para Etest y CLSI se leyeron visualmente tras 24 h de incubación a 35°C. El punto final para Vitek 2 fue determinado por el equipo. El punto final de CMI para CS se determinó como la menor concentración que produjo disminución significativa (≥50%) de crecimiento con respecto al control. El punto final para AMB se leyó como la menor concentración que produjo inhibición total (100%) de crecimiento. Se utilizaron las cepas C.parapsilosis ATCC 22019 y C.krusei ATCC 6258 como control de calidad, de acuerdo a las recomendaciones del CLSI. Los métodos Etest y Vitek 2 fueron capaces de detectar aislados susceptibles en todas las cepas evaluadas. Las CMI estuvieron dentro de los valores esperados. Los resultados mostraron buena concordancia esencial (98%) entre microdilución en caldo y Etest y entre Etest y Vitek (65%), Por lo tanto se recomienda su uso en la evaluación de susceptibilidad in vitro a caspofungina y anfotericina B como método alternativo para los laboratorios asistenciales. Se requieren estudios adicionales para verificar la habilidad de Vitek 2 en la identificación de cepas resistentes a AMB y CS

The aim of the study was to test the susceptibility of Candida spp., against caspofungina and amphotericin B with CLSI broth microdilution (BMD), Etest and an automated system Vitek2. We determined the Minimal Inhibitory Concentration (MIC) from 208 Candida spp. isolates recovered from candidemia patients, to caspofungina and amphotericin B, with broth microdilution (M27-A3 CLSI document), Etest and Vitek. BMD and Etest MICs were read visually after 24 h incubation at 35 ºC. Vitek2 endpoints were determined spectrophotometrically by automated components of this equipment. Caspofungina MIC endpoint was determined as the lowest concentration that caused a significant diminution ≥50% of growth below the growth control. Amphotericin B MIC endpoint was read as the lowest concentration that produced the complete inhibition (100%) of growth. Quality control was performed by testing CLSI recommended strains C. parapsilosis ATCC 22019 and C. krusei ATCC 6258. Etest and Vitek methods were able to detect susceptible isolates in all strains tested. MICs were within expected values. Values of essential agreement were good: 98% between CLSI and Etest and 65% between Vitek and Etest. Therefore, they are recommended to test in vitro susceptibility to caspofungina and amphotericin B as a reliable alternative method for using in clinical laboratories. More studies are necessary to verify Vitek´s 2 ability to identify resistance isolates to amphotericin B.

Evolución favorable de trillizos prematuros con candidiasis sistémica neonatal tratados con caspofungina / Successfully evolution of premature triplets with systemic neonatal candidiasis treated with caspofungin

Introducción: Las infecciones por especies de Candida son un problema que se ha incrementado de manera importante en pacientes de las unidades de cuidados intensivos neonatales (UCIN) y son una causa común de morbi-mortalidad en dicha población. La anfotericina B ha sido considerada como el principal agente terapéutico antifúngico; sin embargo, se ha asociado con efectos adversos como la fungemia persistente debido al aumento en la resistencia a Candida, particularmente especies no albicans, a menudo resistentes también a otros antifúngicos, como el fluconazol. Casos clínicos: Se trata de recién nacidos trillizos de 29 semanas de gestación, quienes recibieron soporte avanzado en la UCIN, incluyendo ventilación mecánica (VM), inserción de catéteres venosos centrales, nutrición parenteral total (NPT) y varios esquemas de antibióticos de amplio espectro, desarrollando sepsis por Candida parapsillosis en los tres casos; la terapia antifúngica fue iniciada con fluconazol, posteriormente con anfotericina B convencional y anfotericina B liposomal, sin mejoría clínica y con hemocultivos positivos. El deterioro fue revertido después del inicio de caspofungina (2 mg/kg/día) añadida a la anfotericina B liposomal. Los tres pacientes se recuperaron totalmente, sin ningún efecto adverso y con adecuada tolerancia. Conclusiones: La caspofungina resultó ser efectiva y bien tolerada en los pacientes tratados a dosis de 2 mg/kg/ día, por lo que se puede considerar una alternativa de tratamiento de la candidiasis invasiva en neonatos prematuros, aunque la dosis óptima no se ha determinado.

Background: Infections caused by Candida sp. have been significantly increasing in patients in neonatal intensive care units (NICU) and are the most common causes of morbi-mortality in this population group. Amphotericin B has been considered to be the standard antifungal therapy. However, it has been associated with adverse effects such as persistent fungemia due to the increase of Candida resistance, in particular the non-albicans species, similar to the resistance shown by other antifungals such as fluconazol. Clinical cases: Triplets of gestational age of 29 weeks received advanced life support in the NICU, including mechanical ventilation (MV), insertion of venous catheters, total parenteral nutrition (TPN) and multiple regimes of broad-spectrum antibiotics. The three patients developed C. parapsilosis sepsis. Antifungal therapy was initiated with fluconazol prior to the use of conventional amphotericin B and liposomal amphotericin B. There was no clinical improvement and blood cultures remained positive. Clinical improvement was noted after the initiation of caspofungin (2 mg/kg/day) in addition to the use of liposomal amphotericin B. The triplets recovered completely with adequate tolerance to the medication and without adverse effects. Conclusion: Use of caspofungin proved to be an effective and well-tolerated therapy in these patients (2 mg/ kg/day). It can be considered an alternative treatment for invasive candidiasis in premature neonates, although optimal dosage remains undetermined.

Susceptibilidad in vitro de candida spp a caspofungina por los métodos de microdilución y difusión en agar / Caspofungin in vitro susceptibility of candida spp by the methods of microdilution and agar diffusión

Caspofungina (CS) es una equinocandina fungicida que actúa inhibiendo la síntesis de la ß-1,3 -D-glucan componente esencial de la pared celular de los hongos El objetivo de este estudio fue determinar la concentración mínima inhibitoria (CMI) por microdilución en caldo y Etest® de CS en las Candida spp., aisladas de pacientes de la UCI con candidemia, para lo cual se recolectaron 80 aislados de Candida spp., los aislados se identificaron por métodos automatizados Vitek-2 YBC® (bioMérieux, France) y Walkway MicroScan®, se verificó la identificación por métodos convencionales, incluyendo morfología macroscópica y microscópica en agar harina de maíz, uso del medio CHROMagar Candida. La CMI se determinó según el método del CLSI M27-A2 y por Etest®, tomándose como lectura del CMI la concentración que mostrará una reducción significativa ≥ 50% de inhibición con respecto al control de crecimiento. La susceptibilidad de Candida spp., a CS por ambos métodos fue del 100% con una CMI ≤2 µg/ml. Las CMI50/CMI90 por CLSI a las 48h y Etest® a las 24h en el total de Candida spp., fueron (0,51/0,70 y 0,28/0,47) y por especie mayormente aislada C.parapsilosis (0,54/0,78 y 0,37/0,65), C.tropicalis (0,20/0,40 y 0,17/0,25), C.albicans (0,12/0,27 y 0,18/0,35). Se obtuvo un valor de R promedio de 0,85 lo que indica una buena correlación entre ambos métodos. Se demostró que CS presenta una excelente actividad inhibitoria in vitro a todas las especies de Candida por lo que representa una alternativa terapéutica adecuada en pacientes con candidemia y/o candidiasis invasora. El método de E-test® representa una alternativa confiable y reproducible con respecto al método de referencia.

Caspofungina (CS) is a Echinocandins fungicide that acts by inhibiting the synthesis of ß-1, 3-D-glucan essential component of cell walls of fungi study the aim of this was to determine the minimum inhibitory concentration (MIC) in microdilution broth and Etest® CS of Candida spp; isolated from patients in the ICU with Candida in blood for which were collected 80 isolates of Candida spp; from patients in the ICU, isolates were identified by automated method Vitek-2 YBC® (bioMérieux, France) and Walkway MicroScan®, identification was verified by conventional methods, including microscopic and macroscopic morphology in cornmeal agar and use of the medium CHROMagar Candida. The MIC was established by the method of CLSI M27-A2 and Etest®, taking as MIC the point that show a significant reduction ≥ 50% inhibition with respect to control growth. The susceptibility of Candida spp., CS by both methods was 100% with a MIC ≤ 2 µg / ml. The MIC50/MIC90 by CLSI at 48h and 24h Etest ® to all Candida spp. , were (0.51 / 0.70 and 0.28 / 0.47) per species and mostly isolated C.parapsilosis (0.54 / 0.78 and 0.37 / 0.65), C.tropicalis (0.20 / 0.40 and 0.17 / 0.25), C.albicans (0.12 / 0.27 and 0.18 / 0.35). We obtained a value of R average of 0.85 which indicates a good correlation between both methods. It was shown that CS presents an excellent inhibitory activity in vitro all Candida species and therefore represents a therapeutic alternative in appropriate patients with invasive candidiasis. The E-test® method represents an alternative reliable and reproducible with respect to the reference method.

Susceptibilidad de candida spp a fluconazol, voriconazol y caspofungina por el método de difusión con disco / Susceptibility of candida spp to fluconazol, voriconazol and caspofungina by the method of diffusion with disc

En las dos últimas décadas, el aumento de la prevalencia de las candidosis ha sido constante. En nuestro país existe un incremento notable y progresivo de especies distintas a Candida albicans asociado a candidemias, lo que señala la necesidad de identificar las levaduras del genero Candida a nivel de especie, así como la realización de las pruebas de susceptibilidad a los antifúngicos. El objetivo de este trabajo fue determinar la susceptibilidad de Candida spp., a Fluconazol (FZ), Voriconazol (VZ) y Caspofungina (CS) por el método de difusión con discos. Se recolectaron 80 aislados de Candida spp., provenientes de pacientes con candidemia hospitalizados en las UCI de 9 centros hospitalarios del área metropolitana de Caracas (junio 2006 a abril 2008). Los aislados se identificaron por métodos automatizados Vitek-2 YBC® y Walkway MicroScan®, verificando la identificación por métodos convencionales, Chromagar-Candida y morfología en agar harina de maíz. La prueba de difusión con disco se realizó según el documento CLSI M44-A, utilizando discos comerciales de FZ (25µg), VZ (1µg) y discos de CS (5µg) de preparación artesanal. La lectura se realizó a las 24 h de incubación a 35°C, se midió en milímetros el diámetro de la zona de inhibición que producía una reducción significativa ≥ 50% y el criterio de interpretación fue: FZ (S:≥19mm, S-DD:15-18mm, R:≤14mm), VZ (S:≥17mm, S-DD:14-16 mm, R:≤13mm), CS (S:≥11mm, R:≤10mm). Todas las especies de Candida resultaron susceptibles a los 3 antifúngicos ensayados a excepción de un aislado de C.krusei resistente a FZ. Los valores mínimo, máximo y media geométrica de la susceptibilidad en mm fueron: FZ (25/38/30), VZ (26/39/31) y CS (16/21/18). El método de disco difusión es una alternativa útil, rápida y de fácil ejecución para ser implementado en laboratorios de micología y así ofrecer una orientación en el tratamiento antifúngico adecuado y oportuno en candidosis invasora.

During the last two decades, the increase of prevalence of candidosis has been constant. In our country there has been a notable and progressive increment of different species of Candida albicans associated with candidemis, which indicate the need to identify the yeasts of the Candida gender at the specie level, as well as the execution of the susceptibility testing on the antifungal. The purpose of this work was to determine the susceptibility of Candida spp., to Fluconazole (FZ), Voriconazole (VZ) and Caspofungin (CS) by the method of diffusion with disc. There were collected 80 isolates of Candida spp., sampled from patients with candidemia hospitalized at the ICU of 9 hospital centers of the metropolitan area of Caracas (June 2006 to April 2008). The isolates were identified by automated methods, Vitek-2 YBC® and Walkway MicroScan®, and then the identification was verified by a conventional method, Chromagar-Candida and the morphology in corn meal agar. The test of diffusion with disc was performed as per document CLSI M44-A, using commercially available disc of FZ (25µg), VZ (1µg) and discs of CS (5µg) of in-house preparation. The readings were made at 24 h of incubation, at 35°C, thereby measuring in millimeters the diameter of the inhibition zone that generated a significant reduction ≥ 50%, being the criteria of interpretation: FZ (S:≥19mm, S-DD:15-18mm, R:≤14mm), VZ (S:≥17mm, S-DD:14-16 mm, R:≤13mm), CS (S:≥11mm, R:≤10mm). All species of Candida were susceptible against the 3 antifungal assayed with the exception of an isolate of C.krusei which was resistant to FZ. The minimum, maximum and geometric media values for the susceptibility in mm were: FZ (25/38/30), VZ (26/39/31) and CS (16/21/18). The method of diffusion with disc is a useful, quick, and easy to execute and implement alternative by mycology laboratories, in order to offer an orientation regarding the proper and opportune antifungal treatment of invasive candidosis.