Support for the EUCAST and revised CLSI fluconazole clinical breakpoints by Sensititre(R) YeastOne(R) for Candida albicans: a prospective observational cohort study

Hal, S. J. van; Chen, S. C.-A.; Sorrell, Tania C.; Ellis, David; Slavin, Monica A; Marriott, D. M.

doi:10.1093/jac/dku124

Cited by 21 publications

(12 citation statements)

References 17 publications

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“…is predictive of likely antifungal susceptibility (or resistance) and aids selection of antifungal agents (see Table 2 for common susceptibility patterns of major Candida spp.). In Australia, most species, including C. albicans, C. parapsilosis and C. tropicalis, are typically susceptible to fluconazole, 22 while those with reduced susceptibility include C. glabrata and C. krusei. 17,18,23 The emergence of multi-drug resistance in C. glabrata, involving all azoles and echinocandins, 19,20 is of particular concern.…”

Section: Antifungal Susceptibilitymentioning

confidence: 99%

Consensus guidelines for the treatment of yeast infections in the haematology, oncology and intensive care setting, 2014

Chen

Sorrell

Chang

et al. 2014

Internal Medicine Journal

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Pathogenic yeast forms are commonly associated with invasive fungal disease in the immunocompromised host, including patients with haematological malignancies and patients of haemopoietic stem cell transplants. Yeasts include the Candida spp., Cryptococcus spp., Pneumocystis jirovecii and some lesser-known pathogens. Candida species remain the most common cause of invasive yeast infections (and the most common human pathogenic fungi). These guidelines present evidence-based recommendations for the antifungal management of established, invasive yeast infections in adult and paediatric patients in the haematology/oncology setting. Consideration is also given to the critically ill patient in intensive care units, including the neonatal intensive care unit. Evidence for 'preemptive' or 'diagnostic-driven antifungal therapy' is also discussed. For the purposes of this paper, invasive yeast diseases are categorised under the headings of invasive candidiasis, cryptococcosis and uncommon yeast infections. Specific recommendations for the management of Pneumocystis jirovecii are presented in an accompanying article (see consensus guidelines by Cooley et al. appearing elsewhere in this supplement).

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Section: Antifungal Susceptibilitymentioning

confidence: 99%

Consensus guidelines for the treatment of yeast infections in the haematology, oncology and intensive care setting, 2014

Chen

Sorrell

Chang

et al. 2014

Internal Medicine Journal

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“…It now represents, to our knowledge, a suitable method for the routine testing of the susceptibilities of clinical Candida isolates to amphotericin B, flucytosine, fluconazole, itraconazole, posaconazole, voriconazole, and the three echinocandins, particularly when it is used on a large (20). Based on data from a prospective candidemia study, van Hal et al were able to support the revised fluconazole CBP for C. albicans by use of the MICs that were obtained using the SYO method (21).…”

mentioning

confidence: 99%

Antifungal Susceptibility Profiles of Bloodstream Yeast Isolates by Sensititre YeastOne over Nine Years at a Large Italian Teaching Hospital

Posteraro

Spanu

Fiori

et al. 2015

Antimicrob Agents Chemother

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Sensititre YeastOne (SYO) is an affordable alternative to the Clinical and Laboratory Standards Institute (CLSI) reference method for antifungal susceptibility testing. In this study, the MICs of yeast isolates from 1,214 bloodstream infection episodes, generated by SYO during hospital laboratory activity (January 2005 to December 2013), were reanalyzed using current CLSI clinical breakpoints/epidemiological cutoff values to assign susceptibility (or the wild-type [WT] phenotype) to systemic antifungal agents. Excluding Candida albicans (57.4% of all isolates [n ‫؍‬ 1,250]), the most predominant species were Candida parapsilosis complex (20.9%), Candida tropicalis (8.2%), Candida glabrata (6.4%), Candida guilliermondii (1.6%), and Candida krusei (1.3%). Among the non-Candida species (1.9%), 7 were Cryptococcus neoformans and 17 were other species, mainly Rhodotorula species. Over 97% of Candida isolates were susceptible (WT phenotype) to amphotericin B and flucytosine. Rates of susceptibility (WT phenotype) to fluconazole, itraconazole, and voriconazole were 98.7% in C. albicans, 92.3% in the C. parapsilosis complex, 96.1% in C. tropicalis, 92.5% in C. glabrata, 100% in C. guilliermondii, and 100% (excluding fluconazole) in C. krusei. The fluconazole-resistant isolates consisted of 6 C. parapsilosis complex isolates, 3 C. glabrata isolates, 2 C. albicans isolates, 2 C. tropicalis isolates, and 1 Candida lusitaniae isolate. Of the non-Candida isolates, 2 C. neoformans isolates had the non-WT phenotype for susceptibility to fluconazole, whereas Rhodotorula isolates had elevated azole MICs. Overall, 99.7% to 99.8% of Candida isolates were susceptible (WT phenotype) to echinocandins, but 3 isolates were nonsusceptible (either intermediate or resistant) to caspofungin (C. albicans, C. guilliermondii, and C. krusei), anidulafungin (C. albicans and C. guilliermondii), and micafungin (C. albicans). However, when the intrinsically resistant non-Candida isolates were included, the rate of echinocandin nonsusceptibility reached 1.8%. In summary, the SYO method proved to be able to detect yeast species showing antifungal resistance or reduced susceptibility.

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“…A dose/MIC of Ͼ400 may be difficult to safely achieve for C. albicans with MICs in the upper range of CLSI susceptible or susceptible dose-dependent breakpoints (Յ2 and 4 mg/liter, respectively) (4,18). In accordance with these findings, a study of 217 patients with C. albicans fungemia (including 8 isolates with MICs of Ͼ2 mg/liter) who received treatment with fluconazole monotherapy (with ϳ70% receiving doses of Ն400 mg/ day) found an MIC of Ն2 mg/liter to be independently associated with infection-related mortality by multivariate analysis (OR, 8.2; 95% CI, 2.3 to 29.7; P ϭ 0.001) (26). Both studies suggest that a breakpoint of Յ1 mg/liter (or perhaps Յ0.5 mg/liter) may be more appropriate for infections due to C. albicans.…”

Section: Fluconazole Susceptibility and Treatment Successmentioning

confidence: 55%

Are In Vitro Susceptibilities to Azole Antifungals Predictive of Clinical Outcome in the Treatment of Candidemia?

2018

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The purpose of this review is to critically analyze published data evaluating the impact of azole pharmacokinetic and pharmacodynamic parameters, MICs, and species on clinical outcomes in patients with candidemia. Clinical breakpoints (CBPs) for fluconazole and voriconazole, which are used to determine susceptibility, have been defined by the Clinical and Laboratory Standards Institute (CLSI) for species. Studies evaluating the relationship between treatment efficacy and susceptibility, as well as the pharmacodynamic targets, have been conducted in patients treated with fluconazole for candidemia; however, for species other than and , and for other forms of invasive candidiasis, data remain limited and randomized trials are not available. Limited data evaluating these relationships with voriconazole are available. While pharmacodynamic targets for posaconazole and isavuconazole have been proposed based upon studies conducted in murine models, CBPs have not been established by CLSI. Fluconazole remains an important antifungal agent for the treatment of candidemia, and data supporting its use based on susceptibility are growing, particularly for and Further investigation is needed to establish the roles of voriconazole, posaconazole, and isavuconazole in the treatment of candidemia and for all agents in the treatment of other forms of invasive candidiasis.

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Support for the EUCAST and revised CLSI fluconazole clinical breakpoints by Sensititre(R) YeastOne(R) for Candida albicans: a prospective observational cohort study

Abstract: We observed a direct relationship between infection-related mortality and rising fluconazole MIC for C. albicans candidaemia; overall, the data support the EUCAST and revised CLSI fluconazole clinical breakpoints.

Cited by 21 publications

References 17 publications

Consensus guidelines for the treatment of yeast infections in the haematology, oncology and intensive care setting, 2014

Consensus guidelines for the treatment of yeast infections in the haematology, oncology and intensive care setting, 2014

Antifungal Susceptibility Profiles of Bloodstream Yeast Isolates by Sensititre YeastOne over Nine Years at a Large Italian Teaching Hospital

Are In Vitro Susceptibilities to Azole Antifungals Predictive of Clinical Outcome in the Treatment of Candidemia?

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