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. 2021 Oct 18;65(11):e0109321.
doi: 10.1128/AAC.01093-21. Epub 2021 Aug 9.

Etest ECVs/ECOFFs for Detection of Resistance in Prevalent and Three Nonprevalent Candida spp. to Triazoles and Amphotericin B and Aspergillus spp. to Caspofungin: Further Assessment of Modal Variability

A Espinel-Ingroff  1 , M Sasso  2 , J Turnidge  3 , M Arendrup  4 , F Botterel  5 , N Bourgeois  6 , B Bouteille  7 , E Canton  8 , S Cassaing  9 , E Dannaoui  10 , M Dehais  11 , L Delhaes  12 , D Dupont  13 , A Fekkar  14 , J Fuller  15 , G Garcia-Effron  16 , J Garcia  17 , G M Gonzalez  18 , N P Govender  19 , H Guegan  20 , J Guinea  21 , S Houzé  22 , C Lass-Flörl  23 , T Pelaez  24 , A Forastiero  25 , M Lackner  23 , R Magobo  19
Affiliations

Etest ECVs/ECOFFs for Detection of Resistance in Prevalent and Three Nonprevalent Candida spp. to Triazoles and Amphotericin B and Aspergillus spp. to Caspofungin: Further Assessment of Modal Variability

A Espinel-Ingroff et al. Antimicrob Agents Chemother. .

Abstract

Susceptibility testing is an important tool in the clinical setting; its utility is based on the availability of categorical endpoints, breakpoints (BPs), or epidemiological cutoff values (ECVs/ECOFFs). CLSI and EUCAST have developed antifungal susceptibility testing, BPs, and ECVs for some fungal species. Although the concentration gradient strip bioMérieux Etest is useful for routine testing in the clinical laboratory, ECVs are not available for all agent/species; the lack of clinical data precludes development of BPs. We reevaluated and consolidated Etest data points from three previous studies and included new data. We defined ECOFFinder Etest ECVs for three sets of species-agent combinations: fluconazole, posaconazole, and voriconazole and 9 Candida spp.; amphotericin B and 3 nonprevalent Candida spp.; and caspofungin and 4 Aspergillus spp. The total of Etest MICs from 23 laboratories (Europe, the Americas, and South Africa) included (antifungal agent dependent): 17,242 Candida albicans, 244 C. dubliniensis, 5,129 C. glabrata species complex (SC), 275 C. guilliermondii (Meyerozyma guilliermondii), 1,133 C. krusei (Pichia kudriavzevii), 933 C. kefyr (Kluyveromyces marxianus), 519 C. lusitaniae (Clavispora lusitaniae), 2,947 C. parapsilosis SC, 2,214 C. tropicalis, 3,212 Aspergillus fumigatus, 232 A. flavus, 181 A. niger, and 267 A. terreus SC isolates. Triazole MICs for 66 confirmed non-wild-type (non-WT) Candida isolates were available (ERG11 point mutations). Distributions fulfilling CLSI ECV criteria were pooled, and ECOFFinder Etest ECVs were established for triazoles (9 Candida spp.), amphotericin B (3 less-prevalent Candida spp.), and caspofungin (4 Aspergillus spp.). Etest fluconazole ECVs could be good detectors of Candida non-WT isolates (59/61 non-WT, 4 of 6 species).

Keywords: Aspergillus spp.; Candida; ECOFFS; ECVs; ERG11 mutants; amphotericin B; antifungal resistance; caspofungin; nonprevalent Candida; triazoles.

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