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This study included 676 surgery patients with signs and symptoms indicative of wound infections, who presented over the course of 6 years. Bacterial pathogens were isolated from 614 individuals. A single etiologic agent was identified in 271 patients, multiple agents were found in 343, and no agent was identified in 62. A high preponderance of aerobic bacteria was observed. Among the common pathogens wereStaphylococcus aureus (191 patients, 28.2%),Pseudomonas aeruginosa (170 patients, 25.2%),Escherichia coli (53 patients, 7.8%), Staphylococcus epidermidis (48 patients, 7.1%), and Enterococcus faecalis (38 patients, 5.6%).

¼ 2) and posaconazole (ATU ¼ 0.25) against A. terreus. Implications: EUCAST-AFST has released ten new documents summarizing existing and new breakpoints and MIC ranges for control strains. A failure to adopt the breakpoint changes may lead to misclassifications and suboptimal or inappropriate therapy of patients with fungal infections.

Our study shows that candidemia is a significant source of morbidity and mortality. The identification of risk factors associated with mortality along with the knowledge of local susceptibility may lead to a better management in terms of preventive and therapeutic measures.

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Candida tropicalis is less commonly isolated from clinical specimens than Candida albicans. Unlike C. albicans, which can be occasionally found as a commensal, C. tropicalis is almost always associated with the development of fungal infections. In addition, C. tropicalis has been reported to be resistant to fluconazole (FLC). To analyze the development of FLC resistance in C. tropicalis, an FLC-susceptible strain (ATCC 750) (MIC ‫؍‬ 1.0 g/ml) was cultured in liquid medium containing increasing FLC concentrations from 8.0 to 128 g/ml. The strain developed variable degrees of FLC resistance which paralleled the concentrations of FLC used in the medium. The highest MICs of FLC were 16, 256, and 512 g/ml for strains grown in medium with 8.0, 32, and 128 g of FLC per ml, respectively. Development of resistance was rapid and could be observed already after a single subculture in azole-containing medium. The resistant strains were cross-resistant to itraconazole (MIC > 1.0 g/ml) and terbinafine (MIC > 512 g/ml) but not to amphotericin B. Isolates grown in FLC at concentrations of 8.0 and 32 g/ml reverted to low MICs (1.0 g/ml) after 12 and 11 passages in FLC-free medium, respectively. The MIC for one isolate grown in FLC (128 g/ml) (128 R) reverted to 16 g/ml but remained stable over 60 passages in FLC-free medium. Azole-resistant isolates revealed upregulation of two different multidrug efflux transporter genes: the major facilitators gene MDR1 and the ATP-binding cassette transporter CDR1. The development of FLC resistance in vitro correlated well with the results obtained in an experimental model of disseminated candidiasis. While FLC given at 10 mg/kg of body weight/ day was effective in reducing the fungal burden of mice infected with the parent strain, the same dosing regimen was ineffective in mice infected with strain 128 R. Finally, the acquisition of in vitro FLC resistance in strain 128 R was related to a loss of virulence. The results of our study elucidate important characteristics and potential mechanisms of FLC resistance in C. tropicalis.

The aim of this study was to compare MICs of fluconazole, itraconazole, posaconazole, and voriconazole obtained by the European Committee on Antibiotic Susceptibility Testing (EUCAST) and CLSI (formerly NCCLS) methods in each of six centers for 15 Candida albicans (5 fluconazole-resistant and 4 susceptibledose-dependent [S-DD] isolates), 10 C. dubliniensis, 7 C. glabrata (2 fluconazole-resistant isolates), 5 C. guilliermondii (2 fluconazole-resistant isolates), 10 C. krusei, 9 C. lusitaniae, 10 C. parapsilosis, and 5 C. tropicalis (1 fluconazole-resistant isolate) isolates. CLSI MICs were obtained visually at 24 and 48 h and spectrophotometric EUCAST MICs at 24 h. The agreement (within a 3-dilution range) between the methods was species, drug, and incubation time dependent and due to lower EUCAST than CLSI MICs: overall, 94 to 95% with fluconazole and voriconazole and 90 to 91% with posaconazole and itraconazole when EUCAST MICs were compared against 24-h CLSI results. The agreement was lower (85 to 94%) against 48-h CLSI endpoints. The overall interlaboratory reproducibility by each method was >92%. When the comparison was based on CLSI breakpoint categorization, the agreement was 68 to 76% for three of the four species that included fluconazoleresistant and S-DD isolates; 9% very major discrepancies (<8 g/ml versus >64 g/ml) were observed among fluconazole-resistant isolates and 50% with voriconazole (<1 g/ml versus >4 g/ml). Similar results were observed with itraconazole for seven of the eight species evaluated (28 to 77% categorical agreement). Posaconazole EUCAST MICs were also substantially lower than CLSI MIC modes (0.008 to 1 g/ml versus 1 to >8 g/ml) for some of these isolates. Therefore, the CLSI breakpoints should not be used to interpret EUCAST MIC data.Candida spp. and Aspergillus spp. are responsible for the majority (80 to 90%) of fungal infections. During the last two years, two new antifungal agents (the echinocandin caspofungin and the triazole voriconazole) have been licensed for the systemic treatment of fungal infections. Other triazoles (posaconazole and ravuconazole) and echinocandins (anidulafungin and micafungin) are undergoing phase III clinical trials. The increasing number of fungal infections and new antifungal agents has underscored the need for testing the antifungal susceptibilities of fungal pathogens to these agents. The Clinical and Laboratory Standards Institute (CLSI; formerly the National Committee for Clinical Laboratory Standards [NCCLS]) has developed a reference method (CLSI [formerly NCCLS] M27-A2 document) for antifungal susceptibility testing of Candida spp. and Cryptococcus neoformans (6). Agreement has been demonstrated between CLSI results and those obtained by a broth microdilution method with the following testing guidelines (1-3, 8-10): (i) RPMI 1640 with 2% dextrose medium to enhance the growth of yeast cells; (ii) an inoculum size of 0.5 ϫ 10 5 to 2.5 ϫ 10 5 CFU/ml; (iii) flat-bottom microdilution trays; and (iv) 24-h spectrophotometric MICs. Based on those s...