Characterisation of breakthrough invasive mycoses in echinocandin recipients: an evidence-based review

Sun, Hsin‐Yun; Singh, Nina

doi:10.1016/j.ijantimicag.2009.09.020

Cited by 66 publications

(56 citation statements)

References 77 publications

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“…Prior to the availability of the echinocandins, concern over the reduced azole susceptibility of C. glabrata was a major issue for clinicians (10,22,29,32,54). Both in vitro and clinical studies have documented excellent activities of the echinocandins against C. glabrata and other potentially azole-resistant species, and the echinocandins have been rapidly replacing the azoles as first-line therapy for IC (4,17,18,24,30,33,35,55,58). Thus, in addition to the continued high use of azoles, the significant increase in the use of echinocandins places considerable selection pressure on C. glabrata, resulting in the emergence of MDR strains.…”

Section: Resultsmentioning

confidence: 99%

“…causing invasive candidiasis (IC), is distinctly uncommon (1,18,39,46,48,(55)(56)(57)(58)62). Among 15,269 clinical isolates of Candida spp.…”

mentioning

confidence: 99%

“…Although documentation of acquired resistance to the echinocandins remains sporadic (3,18,37,44,48,58,62), several recent reports of acquired resistance in clinical isolates of C. glabrata focus concern on this species (5, 7, 11-15, 18, 19, 48, 58, 59, 62).…”

mentioning

confidence: 99%

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Frequency of Decreased Susceptibility and Resistance to Echinocandins among Fluconazole-Resistant Bloodstream Isolates of Candida glabrata

et al. 2012

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The echinocandin class of antifungal agents is considered to be the first-line treatment of bloodstream infections (BSI) due to Candida glabrata. Recent reports of BSI due to strains of C. glabrata resistant to both fluconazole and the echinocandins are of concern and prompted us to review the experience of two large surveillance programs, the SENTRY Antimicrobial Surveillance Program for the years 2006 through 2010 and the Centers for Disease Control and Prevention population-based surveillance conducted in 2008 to 2010. The in vitro susceptibilities of 1,669 BSI isolates of C. glabrata to fluconazole, voriconazole, anidulafungin, caspofungin, and micafungin were determined by CLSI broth microdilution methods. Fluconazole MICs of >64 g/ml were considered resistant. Strains for which anidulafungin and caspofungin MICs were >0.5 g/ml and for which micafungin MICs were >0.25 g/ml were considered resistant. A total of 162 isolates (9.7%) were resistant to fluconazole, of which 98.8% were nonsusceptible to voriconazole (MIC > 0.5 g/ml) and 9.3%, 9.3%, and 8.0% were resistant to anidulafungin, caspofungin, and micafungin, respectively. There were 18 fluconazole-resistant isolates that were resistant to one or more of the echinocandins (11.1% of all fluconazole-resistant isolates), all of which contained an acquired mutation in fks1 or fks2. By comparison, there were no echinocandin-resistant strains detected among 110 fluconazole-resistant isolates of C. glabrata tested in 2001 to 2004. These data document the broad emergence of coresistance over time to both azoles and echinocandins in clinical isolates of C. glabrata.

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Section: Resultsmentioning

confidence: 99%

“…causing invasive candidiasis (IC), is distinctly uncommon (1,18,39,46,48,(55)(56)(57)(58)62). Among 15,269 clinical isolates of Candida spp.…”

mentioning

confidence: 99%

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Frequency of Decreased Susceptibility and Resistance to Echinocandins among Fluconazole-Resistant Bloodstream Isolates of Candida glabrata

et al. 2012

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“…In order to establish a relationship between MIC and clinical outcome, one requires not only sufficient numbers of resistant isolates but also a sufficient number of patients treated with the drug to which the isolate is later shown to be resistant (17,86). It is often well after a given drug is introduced into clinical practice that sufficient numbers of clinical failures or breakthrough infections are detected to allow the establishment of a resistant susceptibility testing category (70,91). Antifungal resistance can lead to breakthrough invasive fungal infections in high-risk patients receiving antifungal prophylaxis.…”

Section: Rationale For Clinical Impact Of and Recommendations For Tmentioning

confidence: 99%

Progress in Antifungal Susceptibility Testing of Candida spp. by Use of Clinical and Laboratory Standards Institute Broth Microdilution Methods, 2010 to 2012

2012

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Antifungal susceptibility testing of Candida has been standardized and refined and now may play a useful role in managing Candida infections. Important new developments include validation of 24-h reading times for all antifungal agents and the establishment of species-specific epidemiological cutoff values (ECVs) for the systemically active antifungal agents and both common and uncommon species of Candida . The clinical breakpoints (CBPs) for fluconazole, voriconazole, and the echinocandins have been revised to provide species-specific interpretive criteria for the six most common species. The revised CBPs not only are predictive of clinical outcome but also provide a more sensitive means of identifying those strains with acquired or mutational resistance mechanisms. This brief review serves as an update on the new developments in the antifungal susceptibility testing of Candida spp. using Clinical and Laboratory Standards Institute (CLSI) broth microdilution (BMD) methods.

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“…Although resistance to these agents among clinical isolates of opportunistic fungi is considered uncommon, increased resistance and breakthrough infections have been observed among patients with longterm exposure to even the newest antifungal agents (19)(20)(21)(22)(23)(24)(25). These observations have prompted a call for enhanced surveillance efforts and an expanded role for antifungal susceptibility testing, especially for Candida and Aspergillus spp.…”

mentioning

confidence: 99%

In Vitro Activities of Isavuconazole and Comparator Antifungal Agents Tested against a Global Collection of Opportunistic Yeasts and Molds

et al. 2013

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Isavuconazole is a new broad-spectrum triazole with a favorable pharmacokinetic and safety profile. We report the MIC distributions for isavuconazole and 111 isolates of Candida (42 Candida albicans, 25 Candida glabrata, 22 Candida parapsilosis, 14 Candida tropicalis, and 8 Candida krusei isolates), as determined by Clinical and Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility Testing (EUCAST) broth microdilution (BMD) methods. Also, the relative activities of isavuconazole, itraconazole, fluconazole, posaconazole, voriconazole, and the three echinocandins were assessed against a recent (2011) global collection of 1,358 isolates of Candida spp., 101 of Aspergillus spp., 54 of non-Candida yeasts, and 21 of non-Aspergillus molds using CLSI BMD methods. The overall essential agreement (EA) (؎2 log 2 dilutions) between the CLSI and EUCAST methods was 99.1% (EA at ؎1 log 2 dilution, 90.1% [range, 80.0 to 100.0%]). The activities of isavuconazole against the larger collection of Candida spp. and Aspergillus spp. were comparable to those of posaconazole and voriconazole; the MIC 90 values for isavuconazole, posaconazole, and voriconazole against Candida spp. were 0.5, 1, and 0.25 g/ml and against Aspergillus spp. were 2, 1, and 1 g/ml, respectively. Isavuconazole showed good activities against Cryptococcus neoformans (MIC 90 , 0.12 g/ml) and other non-Candida yeasts (MIC 90 , 1 g/ml) but was less potent against non-Aspergillus molds (MIC 90 , >8 g/ml). Isavuconazole MIC values for three mucormycete isolates were 4, 1, and 2 g/ml, whereas all three were inhibited by 1 g/ml posaconazole. Isavuconazole demonstrates broad-spectrum activity against this global collection of opportunistic fungi, and the CLSI and EUCAST methods can be used to test this agent against Candida, with highly comparable results.

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Characterisation of breakthrough invasive mycoses in echinocandin recipients: an evidence-based review

Cited by 66 publications

References 77 publications

Frequency of Decreased Susceptibility and Resistance to Echinocandins among Fluconazole-Resistant Bloodstream Isolates of Candida glabrata

Frequency of Decreased Susceptibility and Resistance to Echinocandins among Fluconazole-Resistant Bloodstream Isolates of Candida glabrata

Progress in Antifungal Susceptibility Testing of Candida spp. by Use of Clinical and Laboratory Standards Institute Broth Microdilution Methods, 2010 to 2012

In Vitro Activities of Isavuconazole and Comparator Antifungal Agents Tested against a Global Collection of Opportunistic Yeasts and Molds

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