In Vitro Fluconazole and Voriconazole Susceptibilities of Candida Bloodstream Isolates in Korea: Use of the CLSI and EUCAST Epidemiological Cutoff Values
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Background: At present, the clinical breakpoints (CBPs) of both fluconazole and voriconazole are available only for 3 common Candida species in the Clinical and Laboratory Standards Institute (CLSI) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST) methods. Epidemiological cutoff values (ECVs) were recently applied to both methods to detect the emergence of acquired resistance (i.e., non-wild-type isolates)among 5 common Candida species. Methods: We performed a nationwide study to determine the fluconazole and voriconazole susceptibility of Candida bloodstream isolates (BSIs) using both the CLSI and EUCAST methods. A total of 423 BSIs of 5 Candida species were collected from 8 hospitals. The azole susceptibilities were assessed on the basis of the species-specific CBPs and ECVs. Results: Of the 341 BSIs of 3 common Candida species (i.e., C. albicans, C. tropicalis,and C. parapsilosis), 0.3% and 0.9%, 0.0% and 1.5% of isolates were categorized as fluconazole and voriconazole resistant according to the CLSI and EUCAST CBPs, respectively. Of 423 total BSIs, 1.4% and 2.6% had fluconazole minimum inhibitory concentrations (MICs) exceeding the ECVs according to the CLSI and EUCAST, respectively; 1.0% and 2.1% had voriconazole MICs exceeding the ECVs according to the CLSI and EUCAST, respectively. Categorical agreement between the methods using ECVs was 98.3% for fluconazole and 98.3% for voriconazole. Conclusions: The EUCAST and CLSI methods using ECVs provide highly concordant results. Moreover, non-wild-type isolates with possibly acquired azole resistance were rare among the BSIs of 5 common Candida species in Korea.
Abstract
Background: At present, the clinical breakpoints (CBPs) of both fluconazole and voriconazole are available only for 3 common Candida species in the Clinical and Laboratory Standards Institute (CLSI) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST) methods. Epidemiological cutoff values (ECVs) were recently applied to both methods to detect the emergence of acquired resistance (i.e., non-wild-type isolates)among 5 common Candida species. Methods: We performed a nationwide study to determine the fluconazole and voriconazole susceptibility of Candida bloodstream isolates (BSIs) using both the CLSI and EUCAST methods. A total of 423 BSIs of 5 Candida species were collected from 8 hospitals. The azole susceptibilities were assessed on the basis of the species-specific CBPs and ECVs. Results: Of the 341 BSIs of 3 common Candida species (i.e., C. albicans, C. tropicalis,and C. parapsilosis), 0.3% and 0.9%, 0.0% and 1.5% of isolates were categorized as fluconazole and voriconazole resistant according to the CLSI and EUCAST CBPs, respectively. Of 423 total BSIs, 1.4% and 2.6% had fluconazole minimum inhibitory concentrations (MICs) exceeding the ECVs according to the CLSI and EUCAST, respectively; 1.0% and 2.1% had voriconazole MICs exceeding the ECVs according to the CLSI and EUCAST, respectively. Categorical agreement between the methods using ECVs was 98.3% for fluconazole and 98.3% for voriconazole. Conclusions: The EUCAST and CLSI methods using ECVs provide highly concordant results. Moreover, non-wild-type isolates with possibly acquired azole resistance were rare among the BSIs of 5 common Candida species in Korea.
참고문헌 (19)
- Pfaller MA, "Wildtype MIC distributions, epidemiological cutoff values and species-specific clinical breakpoints for fluconazole and Candida: time for harmonization of CLSI and EUCAST broth microdilution methods", Drug Resist Updat, 13, pp.180~195 (2010)
- Pfaller MA, "Clinical breakpoints for voriconazole and Candida spp. revisited: review of microbiologic, molecular, pharmacodynamic, and clinical data as they pertain to the development of species-specific interpretive criteria", Diagn Microbiol Infect Dis, 70, pp.330~343 (2011)
- Pfaller MA, "Progress in antifungal susceptibility testing of Candida spp. by use of Clinical and Laboratory Standards Institute broth microdilution methods, 2010 to 2012", J Clin Microbiol, 50, pp.2846~2856 (2012)
- Clinical and Laboratory Standards Institute, "Reference method for broth dilution antifungal susceptibility testing of yeasts. Approved standard. 3rd ed, M27-A3" (2008), Clinical and Laboratory Standards Institute
- Subcommittee on Antifungal Susceptibility Testing (AFST) of the ESCMID European Committee for Antimicrobial Susceptibility Testing (EUCAST)., "EUCAST definitive document EDef 7.1: method for the determination of broth dilution MICs of antifungal agents for fermentative yeasts", Clin Microbiol Infect, 14, pp.398~405 (2008)
- European Committee on Antimicrobial Susceptibility Testing, Subcommittee on Antifungal Susceptibility Testing, "EUCAST technical note on fluconazole", Clin Microbiol Infect, 14, pp.193~195 (2008)
- European Committee on Antimicrobial Susceptibility Testing, Subcommittee on Antifungal Susceptibility Testing, "EUCAST technical note on voriconazole", Clin Microbiol Infect, 14, pp.985~987 (2008)
- Rambach G, "Susceptibility of Candida species and various moulds to antimycotic drugs: use of epidemiological cutoff values according to EUCAST and CLSI in an 8-year survey", Med Mycol, 49, pp.856~863 (2011)
- Pfaller MA, "Triazole and echinocandin MIC distributions with epidemiological cutoff values for differentiation of wild-type strains from non-wild-type strains of six uncommon species of Candida", J Clin Microbiol, 49, pp.3800~3804 (2011)
- Jung SI, "Multicenter surveillance of species distribution and antifungal susceptibilities of Candida bloodstream isolates in South Korea", Medical Mycology, 48(4), pp.669~674 (2010), TAYLOR & FRANCIS LTD
- Pfaller MA, "Twelve years of fluconazole in clinical practice: global trends in species distribution and fluconazole susceptibility of bloodstream isolates of Candida", Clin Microbiol Infect, 10, pp.S11~S23 (2004)
- Pfaller MA, "Wild-type MIC distributions and epidemiologic cutoff values for fluconazole and Candida: time for new clinical breakpoints?", Curr Fungal Infect Rep, 4, pp.168~174 (2010)
- Tortorano AM, "Candidaemia in Europe: epidemiology and resistance", Int J Antimicrob Agents, 27, pp.359~366 (2006)
- Pfaller MA, "Comparison of the broth microdilution (BMD) method of the European Committee on Antimicrobial Susceptibility Testing with the 24- hour CLSI BMD method for testing susceptibility of Candida species to fluconazole, posaconazole, and voriconazole by use of epidemiological cutoff values", J Clin Microbiol, 49, pp.845~850 (2011)
- Pfaller MA, "Geographic variation in the frequency of isolation and fluconazole and voriconazole susceptibilities of Candida glabrata: an assessment from the ARTEMIS DISK Global Antifungal Surveillance Program", Diagn Microbiol Infect Dis, 67, pp.162~171 (2010)
- Pfaller MA, "Results from the ARTEMIS DISK Global Antifungal Surveillance study, 1997 to 2005: an 8.5-year analysis of susceptibilities of Candida species and other yeast species to fluconazole and voriconazole determined by CLSI standardized disk diffusion testing", J Clin Microbiol, 45, pp.1735~1745 (2007)
- Kim SH, "The relationship between antifungal usage and antifungal susceptibility in clinical isolates of Candida: a multicenter Korean study", Medical Mycology, 47, pp.296~304 (2009), TAYLOR & FRANCIS LTD
- Shin JH, "Changes in karyotype and azole susceptibility of sequential bloodstream isolates from patients with Candida glabrata Candidemia", JOURNAL OF CLINICAL MICROBIOLOGY, 45(8), pp.2385~2391 (2007), AMER SOC MICROBIOLOGY
- Sanguinetti M, "Mechanisms of azole resistance in clinical isolates of Candida glabrata collected during a hospital survey of antifungal resistance", Antimicrob Agents Chemother, 49, pp.668~679 (2005)