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Antimicrob Agents Chemother. 2018 Dec 21;63(1). pii: e01651-18. doi: 10.1128/AAC.01651-18. Print 2019 Jan.

Method-Dependent Epidemiological Cutoff Values for Detection of Triazole Resistance in Candida and Aspergillus Species for the Sensititre YeastOne Colorimetric Broth and Etest Agar Diffusion Methods.

Author information

1
VCU Medical Center, Richmond, Virginia, USA victoria.ingroff@vcuhealth.org.
2
University of Adelaide, Adelaide, Australia.
3
Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain.
4
Unité de Parasitologie, Mycologie, Département de Bactériologie Virologie Hygiène Mycologie Parasitologie, Créteil, France.
5
Grupo de Infección Grave, Instituto de Investigación Sanitaria La Fe, Valencia, Spain.
6
Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología Hospital de Valme, Seville, Spain.
7
Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
8
Public Health Ontario, Toronto, Ontario, Canada.
9
Klinisk Mikrobiologi, Karolinska Universitetlaboratoriet, Karolinska Universitetssjukhuset, Stockholm, Sweden.
10
Université Paris-Descartes, Faculté de Médecine, APHP, Hôpital Européen Georges Pompidou, Unité de Parasitologie-Mycologie, Service de Microbiologie, Paris, France.
11
Laboratorio de Micología y Diagnóstico Molecular, Cátedra de Parasitología y Micología, Facultad de Bioquímica y Ciencias Biológicas, Universidad Nacional del Litoral, Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Santa Fe, Argentina.
12
Universidad Autónoma de Nuevo León, Nuevo León, Mexico.
13
National Institute for Communicable Diseases (Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses), a division of the National Health Laboratory Service and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
14
Hospital General Universitario Gregorio Marañón, Madrid, Spain.
15
SA Pathology National Mycology Reference Centre, Adelaide, Australia.
16
Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria.
17
Departamento de Microbiología, Facultad de Medicina y Enfermería, Universidad de Córdoba, Córdoba, Spain.
18
Hospital Universitario Cruces, Barakaldo, Spain.
19
Hospital Universitario Central de Asturias (HUCA), Fundación para la Investigación Biomédica y la Innovación Biosanitaria del Principado de Asturias (FINBA), Asturias, Spain.
20
Universidad del País Vasco/Euskal Herriko Unibertsitatea, UPV/EHU, Bilbao, Spain.
21
Departamento de Biomedicina Biotecnología y Salud Pública, Universidad de Cádiz, Cadiz, Spain.
22
IIS Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain.
23
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
24
Institute of Microbiology, Università Cattolica del Sacro Cuore, Rome, Italy.
25
University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
26
Department of Pharmaceutical Technology and Biochemistry Faculty of Chemistry, Gdańsk University of Technology, Gdańsk, Poland.
27
Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.
28
Mayo Clinic Rochester, Rochester, Minnesota, USA.
29
Microbiology Laboratory Ospedale San Gerardo, Monza, Italy.
30
Microbiology and Virology Unit IRCCS Policlinico, San Matteo, Pavia, Italy.
31
Microbiology Section, Humanitas Research Hospital, Milan, Italy.
32
Microbiology Laboratory, A.O. Spedali Civili, Brescia, Italy.
33
Microbiology Laboratory, Fondazione IRCCS Cà Granda O. Maggiore Policlinico, Milan, Italy.
34
Microbiology Laboratory, Niguarda Hospital, Milan, Italy.
35
Clinical Microbiology Laboratory, Attikon Hospital Medical School, National and Kapodistrian University of Athens, Athens, Greece.
36
Laboratório Especial de Micologia, Disciplina de Infectologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil.
37
Microbiology Institute, ASST Papa Giovanni XXIII, Bergamo, Italy.
38
Unidad de Micología, Servicio de Microbiología, Hospital Universitario La Fe, Valencia, Spain.
39
Microbiology-ASST Lariana, Como, Italy.
40
Medicina di Laboratorio IRCCS Policlinico San Donato, Milan, Italy.

Abstract

Although the Sensititre Yeast-One (SYO) and Etest methods are widely utilized, interpretive criteria are not available for triazole susceptibility testing of Candida or Aspergillus species. We collected fluconazole, itraconazole, posaconazole, and voriconazole SYO and Etest MICs from 39 laboratories representing all continents for (method/agent-dependent) 11,171 Candida albicans, 215 C. dubliniensis, 4,418 C. glabrata species complex, 157 C. guilliermondii (Meyerozyma guilliermondii), 676 C. krusei (Pichia kudriavzevii), 298 C. lusitaniae (Clavispora lusitaniae), 911 C. parapsilosis sensu stricto, 3,691 C. parapsilosis species complex, 36 C. metapsilosis, 110 C. orthopsilosis, 1,854 C. tropicalis, 244 Saccharomyces cerevisiae, 1,409 Aspergillus fumigatus, 389 A. flavus, 130 A. nidulans, 233 A. niger, and 302 A. terreus complex isolates. SYO/Etest MICs for 282 confirmed non-wild-type (non-WT) isolates were included: ERG11 (C. albicans), ERG11 and MRR1 (C. parapsilosis), cyp51A (A. fumigatus), and CDR2 and CDR1 overexpression (C. albicans and C. glabrata, respectively). Interlaboratory modal agreement was superior by SYO for yeast species and by the Etest for Aspergillus spp. Distributions fulfilling CLSI criteria for epidemiological cutoff value (ECV) definition were pooled, and we proposed SYO ECVs for S. cerevisiae and 9 yeast and 3 Aspergillus species and Etest ECVs for 5 yeast and 4 Aspergillus species. The posaconazole SYO ECV of 0.06 µg/ml for C. albicans and the Etest itraconazole ECV of 2 µg/ml for A. fumigatus were the best predictors of non-WT isolates. These findings support the need for method-dependent ECVs, as, overall, the SYO appears to perform better for susceptibility testing of yeast species and the Etest appears to perform better for susceptibility testing of Aspergillus spp. Further evaluations should be conducted with more Candida mutants.

KEYWORDS:

Aspergillus spp.; Candida albicans ; Candida glabrata ; Etest MICs for fungal mutants; Etest method ECVs; SYO MICs for fungal mutants; SYO method ECVs; antifungal resistance; triazole ECVs

PMID:
30323038
PMCID:
PMC6325216
[Available on 2019-06-21]
DOI:
10.1128/AAC.01651-18
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