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Clin Microbiol Infect. 2019 May 10. pii: S1198-743X(19)30205-8. doi: 10.1016/j.cmi.2019.04.027. [Epub ahead of print]

Multicentre study to determine the Etest epidemiological cut-off values of antifungal drugs in Candida spp. and Aspergillus fumigatus species complex.

Author information

1
Service de Parasitologie-Mycologie, CHU Nîmes, Université Montpellier, Nîmes, France.
2
CHU de Rennes, Institut de Recherche en Santé Environnement et Travail, UMR U1085 Inserm-Université Rennes 1, Rennes, France.
3
Service de Parasitologie-Mycologie, CHU Toulouse, Université Paul Sabatier, Toulouse, France.
4
Service de Parasitologie-Mycologie, CHU Bordeaux, France.
5
AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Parasitologie-Mycologie, F-75013, Paris, France.
6
Hospices Civils de Lyon, Institut des Agents Infectieux, Parasitologie-Mycologie Médicale, Université Lyon 1, France.
7
Unité de Parasitologie-Mycologie, CHU Henri Mondor, APHP, France.
8
Laboratoire de Parasitologie- Mycologie, CHU Rouen, Université de Normandie, EA 7510, Rouen, France.
9
Service de Parasitologie-Mycologie, CHU Montpellier, Université de Montpellier, UMR Mivegec, Montpellier, France.
10
Service de Parasitologie-Mycologie, CHU Limoges, Limoges, France.
11
APHP Bichat, laboratoire de Parasitologie-Mycologie, Paris, France.
12
Université Paris-Descartes, Faculté de Médecine, APHP, Hôpital Européen Georges Pompidou, laboratoire de Parasitologie-Mycologie, département de Microbiologie, Paris, France.
13
Service de Parasitologie-Mycologie, CHU Nîmes, Université Montpellier, Nîmes, France. Electronic address: milene.sasso@chu-nimes.fr.

Abstract

OBJECTIVES:

To determine the Etest-based epidemiological cut-off values (ECVs) for antifungal agents against the most frequent yeast and Aspergillus fumigatus species isolated in 12 French hospitals.

METHODS:

For each antifungal agent, the Etest minimum inhibitory concentrations (MICs) in yeast and A. fumigatus isolates from 12 French laboratories were retrospectively collected from 2004 to 2018. The ECVs were then calculated using the iterative statistical method with a 97.5% cut-off.

RESULTS:

Forty-eight Etest ECVs were determined for amphotericin B, caspofungin, micafungin, anidulafungin, fluconazole, voriconazole, posaconazole and itraconazole, after pooling and analysing the MICs of 9,654 Candida albicans, 2,939 Candida glabrata SC, 1,458 Candida parapsilosis SC, 1,148 Candida tropicalis, 575 Candida krusei, 518 Candida kefyr, 241 Candida lusitaniae, 131 Candida guilliermondii, and 1,526 Aspergillus fumigatus species complex isolates. These ECVs were 100% concordant (identical or within one two-fold dilution) with the previously reported Etest-based ECVs (when available), and they were concordant in 76.1% of cases with the Clinical and Laboratory Standards Institute (CLSI) ECVs and in 81.6% of cases with the European Committee on Antimicrobial Susceptibility Testing (EUCAST) ECVs.

CONCLUSIONS:

On the basis of these and other previous results, we recommend the determination of method-dependent ECVs. Etest ECVs should not be used instead of breakpoints, but may be useful to identify non-wild type isolates with potential resistance to antifungal agents, and to suggest that an isolate may not respond as expected to the standard treatment.

KEYWORDS:

Aspergillus; Candida; ECOFF; ECV; Etest; antifungal agents

PMID:
31082487
DOI:
10.1016/j.cmi.2019.04.027

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