Fluconazole resistance is not a predictor of poor outcome in patients with cryptococcosis

Abstract

There is a weak correlation between fluconazole MICs against Cryptococcus spp. as determined by CLSI, EUCAST, E-test and Sensititre YeastOne. Neither procedure could predict the clinical outcome of patients with cryptococcosis receiving fluconazole-based therapy. With present methods, fluconazole resistance in Cryptococcus may be clinically misleading. This article is protected by copyright. All rights reserved.

Comparison of MIC Test Strip and Sensititre YeastOne with the CLSI and EUCAST Broth Microdilution Reference Methods for In Vitro Antifungal Susceptibility Testing of Cryptococcus neoformans

“…This was concordant with the findings presented in previous reports; Mahabeer et al (19) and Ochiuzzi et al (16) reported high essential agreement (within 2 dilutions) between Etest and CLSI (95.1% to 98.5%). However, lower rates of 73%, 76.7%, and 81.1% were found by Aller et al (9), Vena et al (11), and Dannaoui et al (18), respectively. Dias et al (21) reported high levels of essential agreement between EUCAST and Etest (93%), whereas Vena et al (11) presented lower levels (74.5%).…”

“…The agreements between SYO and CLSI and between SYO and EUCAST were 93% and 89%, respectively. In a recent study Vena et al (11) found very low categorical agreement between CLSI and Sensititre (55.5%) and between EUCAST and Sensititre (49.2%). For MTS, the agreement was 95% with the CLSI method and 90% with the EUCAST method.…”

“…Discrepancies between MIC values and clinical outcomes may be partly explained by the antifungal susceptibility test used because MICs may differ between various methods (11) , and automated systems (e.g., Vitek 2). These commercial methods are standardized, effective, simple, and easy to implement in the clinical microbiology laboratory compared with the gold-standard reference techniques, which are tedious, time-consuming, and limited to few centers.…”

Fatores microbiológicos da criptococose e sua importância na carga da doença em pacientes atendidos em um hospital de referência do Estado de São Paulo

“…Além disso, a determinação de breakpoints para Cryptococcus spp. permanece inexistente devido à ausência de estudos capazes de correlacionar resultados de MIC, ou de outro método, com a evolução clínica (ALLER et al, 2000;PFALLER et al, 2005;DANNAOUI et al, 2006;TSENG et al, 2013;CÓRDOBA et al, 2015;VENA et al, 2018 (TURNIDGE et al, 2006;DALHOFF et al, 2009). Os ECV's são determinados pela distribuição de valores de MIC de 95 a 97% dos isolados, em uma curva Gaussiana de distribuição normal, de modo que os isolados são classificados como selvagens quando situados dentro desta distribuição, e em não-selvagens quando excedem, provavelmente devido à mecanismos de resistência adquirida (PFALLER et al, 2011;ESPINEL-INGROFF et al, 2012a, 2012b.…”

“…In addition, the determination of clinical breakpoints for Cryptococcus spp. remains non-existent due to the absence of studies correlating MIC or other susceptibility measures with the clinical prognosis [20][21][22]51,65,66 . All strains presented FCZ-heteroresistant clones however, the LHF was not associated with the severity of cryptococcal meningitis.…”