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. 2020 Jun 2;6(2):76.
doi: 10.3390/jof6020076.

Clinical Usefulness of Susceptibility Breakpoints for Yeasts in the Treatment of Candidemia: A Noninterventional Study

Cornelia Lass-Flörl  1 , Robert Krause  2 , Birgit Willinger  3 , Peter Starzengruber  3 , Petra Decristoforo  1 , Sabrina Neururer  4 , Peter Kreidl  1 , Maria Aigner  1
Affiliations

Clinical Usefulness of Susceptibility Breakpoints for Yeasts in the Treatment of Candidemia: A Noninterventional Study

Cornelia Lass-Flörl et al. J Fungi (Basel). .

Abstract

This prospective noninterventional study evaluated whether antifungal susceptibility data (MIC) provided for Candida clinical isolates on the basis of recently established breakpoints are taken into account by clinicians to guide their treatment decision making process, and assessed the response in MIC- and non-MIC-based treatment groups. During a six month period, the usage of systemic antifungals was recorded in detail and compared with mycological data (Candida species and MICs) in candidemia patients. Patients were assigned to a susceptible or resistant infection group based on European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints; treatment decisions were under the professional discretion of the treating physicians. 123 patients were evaluated with Candida albicans accounting for 59%, Candida glabrata for 19%, Candida parapsilosis for 15%, Candida tropicalis for 4% and Candida krusei for 3%. Antifungal treatment correlated with species and MICs in 80% (n = 99 patients), high MICs and species-dependent guideline recommendations were ignored in 20% (n = 24 patients); the overall outcome of candidemia cases in our study population was excellent, as by day 14, all patients were cleared from fungal blood stream infection (mean 5.6 days, range 2-12). The current variability in antifungal usage and the delay in initiating appropriate therapy indicate a need for antifungal stewardship to improve the management of invasive fungal infections.

Keywords: Candida species; MIC; antifungal susceptibility testing; clinical breakpoints; in vitro versus in vivo outcome.

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Conflict of interest statement

C.L.-F. has received financial support (travel/accommodations/meeting, expenses/payment for lectures, consultancies) from Gilead Sciences, Astellas Pharma, Pfizer, Merck Sharp and Dohme, Basilea. M.A. has received travel grants honorarium as a speaker and consultancy fee from Astellas Pharma, MSD, Gilead. B.W. has received financial support (travel/accommodations/meeting, expenses/payment for lectures, consultancies) from Gilead Sciences, Astellas Pharma, Pfizer, Merck Sharp and Dohme, Basilea. R.K. received research grants from Merck and Pfizer and served on the speakers’ bureau of Pfizer, Gilead, Astellas, Basilea, Merck and Angelini. S.N., P.K. and P.D. have no conflicts of interest.

Figures

Figure 1
Figure 1
Flow chart of patients with proven candidiasis and antifungal treatment.
See this image and copyright information in PMC

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