How to interpret MICs of antifungal compounds according to the revised clinical breakpoints v. 10.0 European committee on antimicrobial susceptibility testing (EUCAST)
| Autor: | M.C. Arendrup, N. Friberg, M. Mares, G. Kahlmeter, J. Meletiadis, J. Guinea, C.T. Andersen, S. Arikan-Akdagli, F. Barchiesi, E. Chryssanthou, P. Hamal, H. Järv, N. Klimko, O. Kurzai, K. Lagrou, C. Lass-Flörl, T. Matos, K. Muehlethaler, T.R. Rogers, A. Velegraki, S. Arikan |
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| Přispěvatelé: | Medical Microbiology & Infectious Diseases |
| Rok vydání: | 2020 |
| Předmět: |
Azoles
0301 basic medicine Microbiology (medical) Antifungal medicine.medical_specialty Posaconazole Antifungal Agents medicine.drug_class Itraconazole 030106 microbiology Susceptible Microbial Sensitivity Tests Echinocandins 03 medical and health sciences 0302 clinical medicine Internal medicine Amphotericin B medicine Susceptible increased exposure 030212 general & internal medicine Fluconazole Candida Voriconazole business.industry Micafungin General Medicine Triazoles Resistant 3. Good health Infectious Diseases Aspergillus Breakpoint Practice Guidelines as Topic Anidulafungin business Intermediate medicine.drug |
| Zdroj: | Clinical Microbiology and Infection, 26(11), 1464-1472. Elsevier Ltd. |
| ISSN: | 1469-0691 1198-743X |
| Popis: | BACKGROUND: EUCAST has revised the definition of the susceptibility category I from 'Intermediate' to 'Susceptible, Increased exposure'. This implies that I can be used where the drug concentration at the site of infection is high, either because of dose escalation or through other means to ensure efficacy. Consequently, I is no longer used as a buffer zone to prevent technical factors from causing misclassifications and discrepancies in interpretations. Instead, an Area of Technical Uncertainty (ATU) has been introduced for MICs that cannot be categorized without additional information as a warning to the laboratory that decision on how to act has to be made. To implement these changes, the EUCAST-AFST (Subcommittee on Antifungal Susceptibility Testing) reviewed all, and revised some, clinical antifungal breakpoints. OBJECTIVES: The aim was to present an overview of the current antifungal breakpoints and supporting evidence behind the changes. SOURCES: This document is based on the ten recently updated EUCAST rationale documents, clinical breakpoint and breakpoint ECOFF documents. CONTENT: The following breakpoints (in mg/L) have been revised or established for Candida species: micafungin against C. albicans (ATU = 0.03); amphotericin B (S ≤/> R = 1/1), fluconazole (S ≤/> R = 2/4), itraconazole (S ≤/> R = 0.06/0.06), posaconazole (S ≤/> R = 0.06/0.06) and voriconazole (S ≤/> R = 0.06/0.25) against C. dubliniensis; fluconazole against C. glabrata (S ≤/> R = 0.001/16); and anidulafungin (S ≤/> R = 4/4) and micafungin (S ≤/> R = 2/2) against C. parapsilosis. For Aspergillus, new or revised breakpoints include itraconazole (ATU = 2) and isavuconazole against A. flavus (S ≤/> R = 1/2, ATU = 2); amphotericin B (S ≤/> R = 1/1), isavuconazole (S ≤ /> R = 1/2, ATU = 2), itraconazole (S ≤/> R = 1/1, ATU = 2), posaconazole (ATU = 0.25) and voriconazole (S ≤/> R = 1/1, ATU = 2) against A. fumigatus; itraconazole (S ≤/> R = 1/1, ATU = 2) and voriconazole (S ≤/> R = 1/1, ATU = 2) against A. nidulans; amphotericin B against A. niger (S ≤/> R = 1/1); and itraconazole (S ≤/> R = 1/1, ATU = 2) and posaconazole (ATU = 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. ispartof: Clin Microbiol Infect vol:26 issue:11 pages:1464-1472 ispartof: location:England status: published |
| Databáze: | OpenAIRE |
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