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In Vitro Fluconazole and Voriconazole Susceptibilities of Candida Bloodstream Isolates in Korea: Use of the CLSI and EUCAST Epidemiological Cutoff Values

 Min Joong Jang  ;  Jong Hee Shin  ;  Wee Gyo Lee  ;  Mi-Na Kim  ;  Kyungwon Lee  ;  Hye Soo Lee  ;  Mi-Kyung Lee  ;  Chulhun L. Chang  ;  Hee-Chang Jang  ;  Eun Song Song  ;  Soo Hyun Kim  ;  Myung-Geun Shin  ;  Soon-Pal Suh  ;  Dong-Wook Ryang 
 ANNALS OF LABORATORY MEDICINE, Vol.33(3) : 167-173, 2013 
Journal Title
Issue Date
Antifungal Agents/pharmacology* ; Candida/drug effects* ; Candida/isolation & purification ; Candidiasis/epidemiology ; Candidiasis/microbiology ; Drug Resistance, Fungal/drug effects ; Fluconazole/pharmacology* ; Humans ; Microbial Sensitivity Tests ; Pyrimidines/pharmacology* ; Republic of Korea ; Triazoles/pharmacology* ; Voriconazole
CLSI ; Candida ; EUCAST ; Fluconazole ; Voriconazole ; epidemiological cutoff value
BACKGROUND: At present, the clinical breakpoints (CBPs) of both fluconazole and voriconazole are available only for 3 common Candida species in the Clinical and Laboratory Standards Institute (CLSI) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST) methods. Epidemiological cutoff values (ECVs) were recently applied to both methods to detect the emergence of acquired resistance (i.e., non-wild-type isolates) among 5 common Candida species. METHODS: We performed a nationwide study to determine the fluconazole and voriconazole susceptibility of Candida bloodstream isolates (BSIs) using both the CLSI and EUCAST methods. A total of 423 BSIs of 5 Candida species were collected from 8 hospitals. The azole susceptibilities were assessed on the basis of the species-specific CBPs and ECVs. RESULTS: Of the 341 BSIs of 3 common Candida species (i.e., C. albicans, C. tropicalis, and C. parapsilosis), 0.3% and 0.9%, 0.0% and 1.5% of isolates were categorized as fluconazole and voriconazole resistant according to the CLSI and EUCAST CBPs, respectively. Of 423 total BSIs, 1.4% and 2.6% had fluconazole minimum inhibitory concentrations (MICs) exceeding the ECVs according to the CLSI and EUCAST, respectively; 1.0% and 2.1% had voriconazole MICs exceeding the ECVs according to the CLSI and EUCAST, respectively. Categorical agreement between the methods using ECVs was 98.3% for fluconazole and 98.3% for voriconazole. CONCLUSIONS: The EUCAST and CLSI methods using ECVs provide highly concordant results. Moreover, non-wild-type isolates with possibly acquired azole resistance were rare among the BSIs of 5 common Candida species in Korea.
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1. College of Medicine (의과대학) > Dept. of Laboratory Medicine (진단검사의학교실) > 1. Journal Papers
Yonsei Authors
Lee, Kyungwon(이경원) ORCID logo https://orcid.org/0000-0003-3788-2134
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