Antifungal susceptibility testing: Which method and when?
|
|
- Hester Chapman
- 5 years ago
- Views:
Transcription
1 Antifungal susceptibility testing: Which method and when? Maiken Cavling Arendrup SSI & Juan Luis Rodriguez Tudela ISCIII
2 Agenda Summary of current standards and selected commercial methods BPs and BP setting process CLSI EUCAST Indications for AFST Conclusion
3 In vitro susceptibility testing Broth-dilution Macro-format Micro-format CLSI Reference method EUCAST Reference method Odds method SensiTitre Disk / Etest diffusion Vitek Agar dilution
4 Yeast standards Free at EUCAST web page!!! 55 $ (non member price including supplement)
5 CLSI M7-A><A><A3 & EUCAST M7-A M7-A M7-A3 EUCAST Glucose /Inoculum size.%,.5-.5 x 3 %,.5-.5 x 5 Plates & Reading Round bottom & Visual Flat & Spec. Incubation time h - h h h End point % inhib. 5% inhib. 5% inhib. 5% inhib C. parapsilosis ATCC 9 C. krusei ATCC 65 - µg/ml.5- / - µg/ml.5- µg/ml.5- µg/ml 6-6 µg/ml -6 / 6- µg/ml -6 µg/ml 6-6 µg/ml
6 Antifungal S, R breakpoints for Candida Breakpoints given as: S: X; R: >Y Proposed Breakpoints- not yet approved!! CLSI EUCAST (specific for) Amphotericin B ; > Anidulafungin.3; >.3 (C. alb).6; >.6 (C. g,k,t) Caspofungin - Micafungin - Fluconazole ; >3 ; > (C. a,t,p) Itraconazole.5; >.5 - Posaconazole -.6; >.6 (C. a,t,p) Voriconazole ; >.5; >.5 (C. a,t,p) EUCAST BP: Clin Microbiol Infect : 93-5 & : 95 97
7 Vitek, Sensititre, Etest & Ref methods Cuenca-Estrella M JCM In press
8 Aspergillus Standards Free at EUCAST web page!!! $ (Non member price)
9 Differences between CLSI M3-A & E. Dis 9. CLSI M-3-A EUCAST-AFST E. DEF 9. Glucose Shape of well Inoculum (cfu/ml) Incubation (h) Reading Endpoint. % Round bottom x Visual optically clear & MEC for echinocandins % Flat bottom -5 x 5 Visual optically clear & MEC for echinocandins
10 A. fumigatus ECOFFs & BP suggestions ECOFF / Susceptible Intermediate Resistant Amphotericin B µg/ml - - Itraconazole µg/ml > Voriconazole µg/ml > Posaconazole.5 µg/ml.5 >.5 Rodriguez-Tudela AAC, Verweij Drug Res Updates 9, Pfaller JCM 9
11 o Voriconazole: 93.3 to % agreement (within 3 dilutions) o independent of the E test incubation time (for four of five species at both incubation times). o Amphotericin B, itraconazole, and posaconazole, o E test results were more dependent on the incubation time for certain species. o Posaconazole and A. fumigatus, o highest agreement at h (95.%) (versus 9% at h)
12 Agenda Summary of current standards and selected commercial methods BPs and BP setting process CLSI EUCAST Indications for AFST Conclusion
13 CLSI vs EUCAST breakpoint establishing procedure CLSI EUCAST MIC distributions PK/PD MIC/Clinical outcome relationships Cumulative % per species From animal models or humans Rule 9-6 Several data sets Epidemiological cutoffs per species Target validated by means of Montecarlo simulations Data mining BP never higher than ECOFF unless supported by clinical data
14 Fluconazole
15 C. tropicalis C. albicans C. glabrata C. krusei C. parapsilosis
16 Summary of epidemiological cut offs values for this bug drug combination EUCAST methodology C. albicans < mg/l C. parapsilosis < mg/l C. tropicalis < mg/l C. glabrata < 3 mg/l C. krusei < mg/l
17 Candidaemia. 6 patients & 6 episodes Oropharyngeal candidiasis. HIV+ patients & 3 episodes A total of 5 episodes of Candida infection were available for analysis
18
19 Distribution between successes and failures of 5 episodes
20 EUCAST Clinical Data MIC in mg/l > mg/d No cure/total % response <.5 / / / / /37.3 >6 3/6.7
21 Strategy to analyze results by data mining Different models have been used: Two decision trees: J and CART A classification rule: One R A probabilistic classifier: Naive Bayes A logistic regression model: Simple logistic Performance of the tests were assessed by means of: Sensitivity and specificity False positive rate Area under ROC curve Matthews Correlation Coefficient (MCC) To check if different algorithms produce similar answers Cuesta I. et al. AAC :99-5.
22 EUCAST clinical data Classifiers MIC value for failures in mg/l Sensitivity in % False positive rate in % Area under ROC curve J > 7.6 CART > 7.9 one R > 7.9 Naïve Bayes Simple Logistic > > 9 3.9
23 CART for all set: 5 cases Predicting failures Node Class = Success LOG_MIC <=.5 Class Cases % Failure 39.5 Success W = 5. N = 5 MIC= mg/l Relative error:. ROC area:.9 Sensitivity: 9% False positive rate: % LOG_MIC <=.5 Terminal Node Class = Success Class Cases % Failure 3.3 Success 9.7 W = 57. N = 57 LOG_MIC >.5 Terminal Node Class = Failure Class Cases % Failure 9. Success.9 W =. N =
24 Clinical BPs for fluconazole have been validated by data mining Susceptible Intermediate Resistant Apply to C. albicans, C. parapsilosis and C. tropicalis But not to EUCAST < mg/l mg/l > mg/l C. krusei which is inherently resistant C. glabrata because BPs divide wild type populations & only 9 cases for analysis
25 Fluconazole Anidulafungin Caspofungin Micafungin mg/ mg mg/ mg 7 mg/5 mg mg 5 mg C. glabrata
26 % of species causing fungal infections Specie Candidemia N (%) OPC N (%) All N (%) Candida albicans (79.) Candida parapsilosis (.) Candida tropicalis --- (.6) Candida glabrata (3.) Other yeast* (.9) All 6 (.) 3 (5.) 5 Other yeast comprise an isolate of the following species: C. krusei, C. guilliermondii, C. kefyr, C. dubliniensis and Geotrichum capitatum
27 One C. glabrata susceptible (MIC = mg/l) to fluconazole according EUCAST BPs S I R < > 5 repetitions in different days
28 One C. glabrata susceptible (MIC = mg/l) to fluconazole according EUCAST BPs 5 S < S I R < > repetitions in different days
29 One C. glabrata susceptible (MIC = mg/l) to fluconazole according EUCAST BPs 5 S < I S I R 5 < > 5 5 repetitions in different days
30 One C. glabrata susceptible (MIC = mg/l) to fluconazole according EUCAST BPs 5 S < I R > S I R 5 < > 5 5 repetitions in different days
31 6 6 BPs divide wild-type population of C. glabrata S < I R >
32 6 6 BPs divide wild-type population of C. glabrata S <
33 BPs divide wild-type population We do not have of C. glabrata clinical data 6 showing MICs < S < 3 3 mg/l respond to fluconazole
34 BPs identify C. krusei as intrinsically resistant to FZ S < I R >
35
36 Voriconazole CLSI vs EUCAST
37 Step : Voriconazole MIC distribution MIC distribution Pfaller JCM 6
38 Step : MIC In vivo outcome Pfaller JCM 6
39 Step Logistic analysis MIC-outcome 9 cases BP suggestion R > μg/ml S.5 /.5 / μg/ml?? BP for resistance (response <6%)
40 CART analysis of studies # 63, 6, 39/6 & 3/66 Node Class = yes MIC <=.9 Class Cases % no 7. yes W = 9. N = 9 ROC area for VZ:.6 MIC <=.9 Terminal Node Class = yes Class Cases % no 36.6 yes 3 7. W = 67. N = 67 MIC >.9 Terminal Node Class = no Class Cases % no 3.5 yes 5.5 W =. N =
41 Step 3: PK/PD data Mouse model Isolates: C. albicans MIC.7.5 μg/ml Human PK/PD AUC ~ μg*h/ml supports a susceptibility BP of μg/ml Andes AAC 3
42 Montecarlo simulation for a PD target
43 Montecarlo simulation for a PD target
44 Choice of susceptibility breakpoint Arguments for S μg/ml No. of isolates Candida spp C. tropicalis C. parapsilosis C. krusei C. glabrata C. albicans MIC distributions Not bisect C. glabrata population includes 99% of isolates Outcome <6% response if MIC > μg/ml for average not for 95% population PK/PD Serum levels frequently μg/ml AUC/MIC will be. MIC (μg/ml)
45 European concerns Outcome C. glabrata 55% versus 7-3% for C. albicans, C. tropicalis and C. parapsilosis Logistic regression for CLSI BPs based on average population and not the lower 95% CI Montecarlo simulations: Target AUC/MIC ~ covers 99% population at a MIC of.5 mg/l for iv MIC of.5 for oral EUCAST data mining does not show any statistical support for in vitro in vivo outcome
46 EUCAST approach for Voriconazole ECOFFs as breakpoint C. glabrata and C. krusei No breakpoints, Insufficient data Voriconazole Rationale for the EUCAST clinical breakpoints, version May. MIC wild type distributions (based on MIC-values determined with EUCAST, CLSI and Etest methodology) Species ECOFF (mg/l)* Candida albicans Candida glabrata Candida krusei Candida parapsilosis Candida tropicalis
47 Echinocandins BPs
48 Step MIC distributions & ECOFFs Anidulafungin. MIC wild type distributions (based on MIC-values determined with EUCAST and Etest methodology*) Species Tot ECOFF (mg/l)** Candida albicans Full distributions Truncated at Truncated at Candida glabrata Full distributions Truncated at Truncated at Candida krusei Full distributions Truncated at Truncated at.6 Candida parapsilosis Candida tropicalis Full distributions 9 3 Truncated at Truncated at.6 Candida guilliermondii
49 Step : MIC - outcome data No such data using EUCAST! Anidulafungin superior to fluconazole C. albicans (35 patients) (% >< 6%) P<.5 C. tropicalis ( patients) (93% >< 5%) P<.5 C. glabrata (3 patients) (56% >< 5%) Candida spp. (7 patients) (75% >< 67% ) Anidulafungin inferior to fluconazole C. parapsilosis (3 patients) (6% >< 3%) Good targets for anidulafungin Poor target for anidulafungin Reboli N Engl J Med 7
50 Step : MIC distribution fks mutants C. albicans C. glabrata A N I No. of isolates MIC (μg/ml) C. albicans (S) C. albicans (R) 6 No. of isolates MIC (μg/ml) C. krusei C. tropicalis C. glabrata (S) C. glabrata (R) 6 MICs for fks mutants C. albicans >.3 C. glabrata >.6 C. krusei >.3/ >.55 C. tropicalis >.6 No. of isolates 6 C. krusei (S) C. krusei (R) No. of isolates C. tropicalis (S) C. tropicalis (R) MIC (μg/ml) MIC (μg/ml) Arendrup AAC
51 Step : MIC distribution fks mutants C. albicans C. glabrata A N I No. of isolates MIC (μg/ml) C. albicans (S) C. albicans (R) 6 No. of isolates MIC (μg/ml) C. krusei C. tropicalis C. glabrata (S) C. glabrata (R) 6 MICs for fks mutants C. albicans >.3 C. glabrata >.6 C. krusei >.3/ >.55 C. tropicalis >.6 No. of isolates 6 C. krusei (S) C. krusei (R) No. of isolates C. tropicalis (S) C. tropicalis (R) MIC (μg/ml) MIC (μg/ml) Arendrup AAC
52 Step 3: No PK/PD ECOFFs as BP Clinical breakpoints C. albicans : S.3, R >.3 mg/l C. glabrata : S.6, R >.6 mg/l C. tropicalis : S.6, R >.6 mg/l C. krusei : S.6, R >.6 mg/l C. parapsilosis & C. guillermondii : no Breakpoints (not good targets) A N I No. of isolates C. albicans C. glabrata C. krusei C. parapsilosis C. tropicalis C. albicans (S) C. albicans (R) 6 No. of isolates C. glabrata (S) C. glabrata (R) 6 No. of isolates C. krusei (S) C. krusei (R) No. of isolates C. parapsilosis (S) 6 No. of isolates C. tropicalis (S) C. tropicalis (R) 6 MIC (μg/ml) MIC (μg/ml) MIC (μg/ml) MIC (μg/ml) MIC (μg/ml) Arendrup et al AAC and EUCAST-AFST
53 Mis-classifications using CLSI BP CLSI BP: Susceptible μg/ml fks hot spot mutants classified as S Anidulafungin Caspofungin Micafungin VMEs CLSI 9.% 6.7% 9.9% Arendrup et al AAC
54 Etest and Anidulafungin < >3 No. of isolates < >3 No. of isolates A N I C. albicans C. glabrata EUCAST draft BP CLSI BP MIC (μg/ml) MIC (μg/ml) C. krusei C. tropicalis C. parapsilosis < >3 < >3 No. of isolates No. of isolates < >3 No. of isolates MIC (μg/ml) MIC (μg/ml) MIC (μg/ml) Arendrup et al AAC and EUCAST-AFST
55 Agenda Summary of current standards and selected commercial methods BPs and BP setting process CLSI EUCAST Indications for AFST Conclusion
56 When? Guiding therapy Invasive mycoses Immunocompromised patients Failure cases Breakthrough isolates preceeding AF therapy Surveillance etc. Epidemiologic studies Uncommon species New compounds Cross resistance issues Breakpoint development process
57 How? Standardized methodology EUCAST CLSI Commercial method validated against reference methodologies ASTY,Etest, Sensititre, Vitek Careful selection of appropriate breakpoints
58 Conclusion Why do we differ?? CLSI BPs species with highest MIC drives the BP BPs have not been adjusted to change in methodology Risk of misclassifying R isolates as S. Very major errors!!!! EUCAST BPs Conservative approach Clinical correlation has to have statistical support if data arise showing isolates with resistance mechanisms are good targets BPs have to be raised My recommendation: Use EUCAST BPs
59 Antifungal S, R breakpoints for Candida Breakpoints given as: S: X; R: >Y Proposed Breakpoints- not yet approved!! CLSI EUCAST (specific for) NRMM (9) Ampho ; > ; > Anidula.3; >.3 (C. alb).6; >.6 (C. g,k,t).5 DK.5 SE Caspo - DK, NO SE, FI Mica - - Fluco ; >3 ; > (C. a,t,p) ; > Itra.5; >.5 -.5; >.5 Posa -.6; >.6 (C. a,t,p).5 DK, SE Vori ; >.5; >.5 (C. a,t,p).5 EUCAST BP: Clin Microbiol Infect : 93-5 & : 95 97
60 Thank you for your attention STATENS SERUM INSTITUT
EUCAST-AFST Available breakpoints 2012
EUCAST-AFST Available breakpoints th NSMM meeting Göteborg, Sweden October th EUCAST-AFST documents Reference Methods Yeast E.DEF. () TN- E.DEF. (CMI epub July) E.DEF. () TN- E.DEF. () Breakpoints Compound
More informationUpdate zu EUCAST 2012 Cornelia Lass-Flörl
Update zu EUCAST 2012 Cornelia Lass-Flörl Frühjahrstagung 2012 Paul-Ehrlich-Gesellschaft Sektion Antimykotische Chemotherapie Bonn, 4./5. Mai 2012 Agenda 1. Breakpoints 2. Rationale documents and technical
More informationMicafungin and Candida spp. Rationale for the EUCAST clinical breakpoints. Version February 2013
Micafungin and Candida spp. Rationale for the EUCAST clinical breakpoints. Version 1.0 5 February 2013 Foreword EUCAST The European Committee on Antimicrobial Susceptibility Testing (EUCAST) is organised
More informationEchinocandin Susceptibility Testing of Candida Isolates Collected during a 1-Year Period in Sweden
JOURNAL OF CLINICAL MICROBIOLOGY, July 2011, p. 2516 2521 Vol. 49, No. 7 0095-1137/11/$12.00 doi:10.1128/jcm.00201-11 Copyright 2011, American Society for Microbiology. All Rights Reserved. Echinocandin
More informationTable 1. Antifungal Breakpoints for Candida. 2,3. Agent S SDD or I R. Fluconazole < 8.0 mg/ml mg/ml. > 64 mg/ml.
AUSTRALIAN ANTIFUNGAL SUSCEPTIBILITY DATA 2008-2011 Part 1: The Yeasts In this article, an update of recent changes to the CLSI antifungal standards for susceptibility testing of yeasts is presented. We
More informationAntifungal Pharmacotherapy
Interpreting Antifungal Susceptibility Testing: Science or Smoke and Mirrors A. W. F O T H E R G I L L, M A, M B A U N I V E R S I T Y O F T E X A S H E A L T H S C I E N C E C E N T E R S A N A N T O
More informationVoriconazole Rationale for the EUCAST clinical breakpoints, version March 2010
Voriconazole Rationale for the EUCAST clinical breakpoints, version 2.0 20 March 2010 Foreword EUCAST The European Committee on Antimicrobial Susceptibility Testing (EUCAST) is organised by the European
More informationReceived 12 December 2010/Returned for modification 5 January 2011/Accepted 16 March 2011
JOURNAL OF CLINICAL MICROBIOLOGY, May 2011, p. 1765 1771 Vol. 49, No. 5 0095-1137/11/$12.00 doi:10.1128/jcm.02517-10 Copyright 2011, American Society for Microbiology. All Rights Reserved. Multicenter
More informationAntifungal Pharmacodynamics A Strategy to Optimize Efficacy
Antifungal Pharmacodynamics A Strategy to Optimize Efficacy David Andes, MD Associate Professor, Department of Medicine Division of Infectious Diseases Medical Microbiology and Immunology University of
More informationReceived 18 December 2008/Returned for modification 9 February 2009/Accepted 9 April 2009
JOURNAL OF CLINICAL MICROBIOLOGY, June 2009, p. 1942 1946 Vol. 47, No. 6 0095-1137/09/$08.00 0 doi:10.1128/jcm.02434-08 Copyright 2009, American Society for Microbiology. All Rights Reserved. Activity
More informationReceived 31 March 2009/Returned for modification 26 May 2009/Accepted 22 June 2009
JOURNAL OF CLINICAL MICROBIOLOGY, Sept. 2009, p. 2766 2771 Vol. 47, No. 9 0095-1137/09/$08.00 0 doi:10.1128/jcm.00654-09 Copyright 2009, American Society for Microbiology. All Rights Reserved. Comparison
More informationAntifungal Resistance in Asia: Mechanisms, Epidemiology, and Consequences
5th MMTN Conference 5-6 November 2016 Bangkok, Thailand 10:20-10:45, 6 Nov, 2016 Antifungal Resistance in Asia: Mechanisms, Epidemiology, and Consequences Yee-Chun Chen, M.D., PhD. Department of Medicine,
More informationon December 9, 2018 by guest
JCM Accepts, published online ahead of print on 27 June 2012 J. Clin. Microbiol. doi:10.1128/jcm.00937-12 Copyright 2012, American Society for Microbiology. All Rights Reserved. 1 2 Progress in Antifungal
More informationReceived 6 October 2010/Returned for modification 26 December 2010/Accepted 7 January 2011
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, Apr. 2011, p. 1580 1587 Vol. 55, No. 4 0066-4804/11/$12.00 doi:10.1128/aac.01364-10 Copyright 2011, American Society for Microbiology. All Rights Reserved. Echinocandin
More information1* 1. Vijaya S. Rajmane, Shivaji T. Mohite
ISSN 2231-4261 ORIGINAL ARTICLE Comparison of the VITEK 2 Yeast Antifungal Susceptibility ing with CLSI Broth Microdilution Reference for ing Four Antifungal Drugs against Candida species Isolated from
More informationResistance epidemiology
ECMM/EFISG symposium: Multidrug resistance in fungi? A formidable foe Resistance epidemiology Ana Alastruey Izquierdo Mycology Reference Lab Spain Instituto de Salud Carlos III Disclousure I have received
More informationMANAGEMENT OF HOSPITAL-ACQUIRED FUNGAL INFECTIONS
MANAGEMENT OF HOSPITAL-ACQUIRED FUNGAL INFECTIONS Paul D. Holtom, MD Associate Professor of Medicine and Orthopaedics USC Keck School of Medicine Numbers of Cases of Sepsis in the United States, According
More informationAn Update in the Management of Candidiasis
An Update in the Management of Candidiasis Daniel B. Chastain, Pharm.D., AAHIVP Infectious Diseases Pharmacy Specialist Phoebe Putney Memorial Hospital Adjunct Clinical Assistant Professor UGA College
More informationAntifungal Drug Resistance: a Cause for Concern?
Antifungal Drug Resistance: a Cause for Concern? Sharon Chen Centre for Infectious Diseases and Microbiology CIDM-PH, CRE in Critical Infections, June 2014 Vis-à-vis bacteria - lesser scale and emotive
More informationReceived 1 December 2009/Accepted 26 January 2010
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, Apr. 2010, p. 1541 1546 Vol. 54, No. 4 0066-4804/10/$12.00 doi:10.1128/aac.01688-09 Copyright 2010, American Society for Microbiology. All Rights Reserved. Evaluation
More informationAntifungals in Invasive Fungal Infections: Antifungals in neutropenic patients
BVIKM-SBIMC La Hulpe, 6 November 2008 Antifungals in Invasive Fungal Infections: Antifungals in neutropenic patients Johan Maertens, MD Acute Leukemia and SCT Unit University Hospital Gasthuisberg Catholic
More informationReceived 13 September 2006/Returned for modification 6 November 2006/Accepted 26 December 2006
JOURNAL OF CLINICAL MICROBIOLOGY, Mar. 2007, p. 858 864 Vol. 45, No. 3 0095-1137/07/$08.00 0 doi:10.1128/jcm.01900-06 Copyright 2007, American Society for Microbiology. All Rights Reserved. Correlation
More informationFKS Mutant Candida glabrata: Risk Factors and Outcomes in Patients With Candidemia
Clinical Infectious Diseases Advance Access published July 9, 2014 MAJOR ARTICLE FKS Mutant Candida glabrata: Risk Factors and Outcomes in Patients With Candidemia Nicholas D. Beyda, 1 Julie John, 1 Abdullah
More informationInterpretive Breakpoints for Fluconazole and Candida Revisited: a Blueprint for the Future of Antifungal Susceptibility Testing
CLINICAL MICROBIOLOGY REVIEWS, Apr. 2006, p. 435 447 Vol. 19, No. 2 0893-8512/06/$08.00 0 doi:10.1128/cmr.19.2.435 447.2006 Copyright 2006, American Society for Microbiology. All Rights Reserved. Interpretive
More informationOslo meeting May 21st 2014
Oslo meeting May 21st 2014 Resistance mechanisms in fungal infections - in Denmark By Rasmus Hare Jensen PhD. student, Mycology Unit, Statens Serum Institut, Copenhagen, Denmark Disclosures 1 Talk divided
More informationAbout the Editor Gerri S. Hall, Ph.D.
About the Editor Gerri S. Hall, Ph.D. Dr. Hall s professional career has been focused on clinical microbiology: direct clinical activities of various areas such as bacteriology, mycobacteria, STD testing,
More informationReceived 21 July 2008/Accepted 3 September 2008
JOURNAL OF CLINICAL MICROBIOLOGY, Nov. 2008, p. 3585 3590 Vol. 46, No. 11 0095-1137/08/$08.00 0 doi:10.1128/jcm.01391-08 Copyright 2008, American Society for Microbiology. All Rights Reserved. Validation
More informationAntifungal Stewardship. Önder Ergönül, MD, MPH Koç University, School of Medicine, Istanbul 6 October 2017, ESGAP course, Istanbul
Antifungal Stewardship Önder Ergönül, MD, MPH Koç University, School of Medicine, Istanbul 6 October 2017, ESGAP course, Istanbul 1 2 Objectives What do we know? Invasive Candida and Aspergillosis Impact
More informationReceived 4 August 2010/Returned for modification 23 October 2010/Accepted 19 November 2010
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, Feb. 2011, p. 561 566 Vol. 55, No. 2 0066-4804/11/$12.00 doi:10.1128/aac.01079-10 Copyright 2011, American Society for Microbiology. All Rights Reserved. Candida
More informationAntifungal Susceptibility Testing
Infect Dis Clin N Am 20 (2006) 699 709 Antifungal Susceptibility Testing Annette W. Fothergill, MA, MBA, MT(ASCP), CLS(NCA) a, Michael G. Rinaldi, PhD a,b, Deanna A. Sutton, PhD, MT, SM(ASCP), SM, RM(NRM)
More informationAAC Accepts, published online ahead of print on 21 March 2011 Antimicrob. Agents Chemother. doi: /aac
AAC Accepts, published online ahead of print on 1 March 0 Antimicrob. Agents Chemother. doi:./aac.010- Copyright 0, American Society for Microbiology and/or the Listed Authors/Institutions. All Rights
More informationReceived 25 September 2006/Returned for modification 4 December 2006/Accepted 26 December 2006
JOURNAL OF CLINICAL MICROBIOLOGY, Mar. 2007, p. 796 802 Vol. 45, No. 3 0095-1137/07/$08.00 0 doi:10.1128/jcm.01986-06 Copyright 2007, American Society for Microbiology. All Rights Reserved. Multicenter
More informationAntifungal susceptibility profiles of Candida isolates from a prospective survey of invasive fungal infections in Italian intensive care units
Journal of Medical Microbiology (2012), 61, 389 393 DOI 10.1099/jmm.0.037895-0 Antifungal susceptibility profiles of Candida isolates from a prospective survey of invasive fungal infections in Italian
More informationNational Center for Emerging and Zoonotic Infectious Diseases AR Lab Network Candida Testing
National Center for Emerging and Zoonotic Infectious Diseases AR Lab Network Candida Testing Snigdha Vallabhaneni, MD, MPH Medical Epidemiologist Centers for Disease Control and Prevention Invasive Candidiasis
More information9/18/2018. Invasive Candidiasis. AR Lab Network Candida Testing. Most Common Healthcare Associated Bloodstream Infection in the United States?
National Center for Emerging and Zoonotic Infectious Diseases AR Lab Network Candida Testing Invasive Candidiasis Snigdha Vallabhaneni, MD, MPH Medical Epidemiologist Centers for Disease Control and Prevention
More informationADEQUATE ANTIFUNGAL USE FOR BLOODSTREAM INFECTIONS
ADEQUATE ANTIFUNGAL USE FOR BLOODSTREAM INFECTIONS COMMERCIAL RELATIONS DISCLOSURE 2500 9000 15000 Astellas Gilead Sciences Pfizer Inc Expert advice Speaker s bureau Speaker s bureau OUTLINE OF THE PRESENTATION
More informationIn vitro cross-resistance between azoles in Aspergillus fumigatus: a reason for concern in the clinic?
4 th Congress on Trends in Medical Mycology (TIMM) In vitro cross-resistance between azoles in Aspergillus fumigatus: a reason for concern in the clinic? Emilia Mellado Mycolgy Reference Laboratory Centro
More informationCandidemia: New Sentinel Surveillance in the 7-County Metro
Candidemia: New Sentinel Surveillance in the 7-County Metro Brittany VonBank, MPH Paula Vagnone, MT (ASCP) 651-201-5414 www.health.state.mn.us Health Care-associated Infections & Antimicrobial Resistance
More informationVoriconazole. Voriconazole VRCZ ITCZ
7 7 8 7 8 fluconazole itraconazole in vitro in vivo Candida spp. C. glabrata C. krusei Cryptococcus neoformans in vitro Aspergillus spp. in vitro in vivo Aspergillus fumigatus Candida albicans C. krusei
More informationThe Evolving Role of Antifungal Susceptibility Testing. Gregory A. Eschenauer and Peggy L. Carver
S PECIAL A RTICLE The Evolving Role of Antifungal Susceptibility Testing Gregory A. Eschenauer and Peggy L. Carver Although increasing numbers of hospital microbiology laboratories are performing antifungal
More informationCD101: A Novel Echinocandin
CD101: A Novel Echinocandin Taylor Sandison, MD MPH Chief Medical Officer TIMM Belgrade, Serbia October 8, 2017 1 Disclosures Dr. Sandison is an employee of and stockholder in Cidara Therapeutics 2 Cidara
More informationESCMID Online Lecture Library. by author
Disclosures Pk/Pd of antifungal drugs Johan W. Mouton MD PhD FIDSA Professor pharmacokinetics and pharmacodynamics Research grants advisory boards speaker Dosing should be such that the level of antmicrobial
More informationFungal Infection in the ICU: Current Controversies
Fungal Infection in the ICU: Current Controversies Andrew F. Shorr, MD, MPH, FCCP, FACP Washington Hospital Center Georgetown University, Washington, DC Disclosures I have served as a consultant to, researcher/investigator
More informationReceived 26 July 2006/Returned for modification 10 October 2006/Accepted 16 October 2006
JOURNAL OF CLINICAL MICROBIOLOGY, Jan. 2007, p. 70 75 Vol. 45, No. 1 0095-1137/07/$08.00 0 doi:10.1128/jcm.01551-06 Copyright 2007, American Society for Microbiology. All Rights Reserved. Use of Fluconazole
More informationAntifungal drug resistance mechanisms in pathogenic fungi: from bench to bedside
REVIEW 10.1111/1469-0691.12495 Antifungal drug resistance mechanisms in pathogenic fungi: from bench to bedside M. Cuenca-Estrella National Center for Microbiology, Instituto de Salud Carlos III, Madrid,
More informationAntifungal therapy in children. Adilia Warris MD PhD FRCPCH Clinical Reader Pediatric Infectious Diseases Specialist
Antifungal therapy in children Adilia Warris MD PhD FRCPCH Clinical Reader Pediatric Infectious Diseases Specialist Invasive fungal infections in Pediatrics Children and adolescents are similarly vulnerable
More informationIsolates from a Phase 3 Clinical Trial. of Medicine and College of Public Health, Iowa City, Iowa 52242, Wayne, Pennsylvania ,
JCM Accepts, published online ahead of print on 26 May 2010 J. Clin. Microbiol. doi:10.1128/jcm.00806-10 Copyright 2010, American Society for Microbiology and/or the Listed Authors/Institutions. All Rights
More informationAnidulafungin for the treatment of candidaemia caused by Candida parapsilosis: Analysis of pooled data from six prospective clinical studies
Received: 1 February 2017 Revised: 11 May 2017 Accepted: 11 May 2017 DOI: 10.1111/myc.12641 ORIGINAL ARTICLE Anidulafungin for the treatment of candidaemia caused by Candida parapsilosis: Analysis of pooled
More informationInterlaboratory variability of caspofungin MICs for Candida spp. using CLSI and EUCAST methods: Should the clinical laboratory be testing this agent?
AAC Accepts, published online ahead of print on 9 September 2013 Antimicrob. Agents Chemother. doi:10.1128/aac.01519-13 Copyright 2013, American Society for Microbiology. All Rights Reserved. 1 2 3 4 5
More informationResearch what you see: Antimicrobial resistance and pathogenesis
Research what you see: Antimicrobial resistance and pathogenesis Director, Mycology Research Unit and XDR Pathogen Laboratory University of Pittsburgh Cornelius J. Clancy, M.D. Chief, Infectious Diseases
More informationon March 29, 2019 by guest
JCM Accepts, published online ahead of print on 4 May 2011 J. Clin. Microbiol. doi:10.1128/jcm.00201-11 Copyright 2011, American Society for Microbiology and/or the Listed Authors/Institutions. All Rights
More informationClinical relevance of resistance in Aspergillus. David W. Denning University Hospital of South Manchester [Wythenshawe Hospital]
Clinical relevance of resistance in Aspergillus David W. Denning University Hospital of South Manchester [Wythenshawe Hospital] The University of Manchester Steps to establishing clinical validity of resistance/susceptibility
More informationReceived 12 May 2010/Returned for modification 24 June 2010/Accepted 6 July 2010
JOURNAL OF CLINICAL MICROBIOLOGY, Sept. 2010, p. 3153 3157 Vol. 48, No. 9 0095-1137/10/$12.00 doi:10.1128/jcm.00952-10 Copyright 2010, American Society for Microbiology. All Rights Reserved. Comparative
More informationCURRENT AND NEWER ANTI-FUNGAL THERAPIES- MECHANISMS, INDICATIONS, LIMITATIONS AND PROBLEMS. Dr AMIT RAODEO DM SEMINAR
CURRENT AND NEWER ANTI-FUNGAL THERAPIES- MECHANISMS, INDICATIONS, LIMITATIONS AND PROBLEMS Dr AMIT RAODEO DM SEMINAR Introduction The incidence of invasive fungal infections in critically ill intensive
More informationCorrelation of the MIC and Dose/MIC ratio of. fluconazole to the therapeutic response of patients with ACCEPTED
AAC Accepts, published online ahead of print on 23 July 2007 Antimicrob. Agents Chemother. doi:10.1128/aac.00296-07 Copyright 2007, American Society for Microbiology and/or the Listed Authors/Institutions.
More informationESCMID Online Lecture Library. by author
What is the best antifungal strategy for severe intra-abdominal infections? Philippe Montravers MD, PhD Anaesthesia and Surgical ICU Bichat Claude Bernard Hospital Assistance Publique Hopitaux de Paris
More informationResearch Article In Vitro Susceptibility of Candida Species to Four Antifungal Agents Assessed by the Reference Broth Microdilution Method
The Scientific World Journal Volume 2013, Article ID 236903, 6 pages http://dx.doi.org/10.1155/2013/236903 Research Article In Vitro Susceptibility of Candida Species to Four Antifungal Agents Assessed
More informationCurrent options of antifungal therapy in invasive candidiasis
Current options of antifungal therapy in invasive candidiasis Saloua Ladeb Bone Marrow Transplant Center Tunis HAMMAMET 24 th April 2012 DEFINITION One or more positive results on blood culture for Candida
More informationUpdated Guidelines for Management of Candidiasis. Vidya Sankar, DMD, MHS April 6, 2017
Updated Guidelines for Management of Candidiasis Vidya Sankar, DMD, MHS April 6, 2017 Statement of Disclosure I have no actual or potential conflict of interest in relation to this presentation Outline
More informationCandida albicans 426 (64.0 ) C. albicans non-albicans
74 2006 1) 2) 1) 3) 4) 5) 6) 1) 2) 3) 4) 5) 6) 17 9 26 18 3 8 2003 10 2004 3 6 9,083 666 (7.3 ) Candida albicans 426 (64.0 ) C. albicans non-albicans 233 (35.0 ) Non-albicans Candida glabrata Candida tropicalis
More informationdida tropicalis, Candida parapsilosis, Candida krusei, Cr. neoformans
dida tropicalis, Candida parapsilosis, Candida krusei, Cr. neoformans Key words: Susceptibility test, IC99, miconazole, fluconazole, itraconazole, Micro-dilution method, 96-multiwell plate Table 1. Cunteffis
More informationComparison of microdilution method and E-test procedure in susceptibility testing of caspofungin against Candida non-albicans species
NEW MICROBIOLOGICA, 31, 257-262, 2008 Comparison of microdilution method and E-test procedure in susceptibility testing of caspofungin against Candida non-albicans species Anna Serefko, Renata Los, Anna
More informationOptimizing antifungal dosing regimens. Joseph Meletiadis, PhD, FECMM Assistant Professor of Microbiology
ATHENA 2017 International Conference November 28 30, 2017 Optimizing antifungal dosing regimens Joseph Meletiadis, PhD, FECMM Assistant Professor of Microbiology Clinical Microbiology Laboratory, «Attikon»
More informationCandidemia epidemiology and susceptibility profile in the largest Brazilian teaching hospital complex
Candidemia epidemiology and susceptibility profile in the largest Brazilian teaching hospital complex ORIGINAL ARTICLE ABSTRACT Introduction: Although the spectrum of fungi causing bloodstream fungal infections
More informationSusceptibility of Candida Species Isolated From HIV Infected and Newborn Candidaemia Patients to Amphotericin B
OnLine Journal of Biological Sciences 10 (2): 109-113, 2010 ISSN 1608-4217 2010 Science Publications Susceptibility of Candida Species Isolated From HIV Infected and Newborn Candidaemia Patients to Amphotericin
More informationSpecies distribution and antifungal susceptibility of bloodstream fungal isolates in paediatric patients in Mexico: a nationwide surveillance study
J Antimicrob Chemother 2013; 68: 2847 2851 doi:10.1093/jac/dkt283 Advance Access publication 18 July 2013 Species distribution and antifungal susceptibility of bloodstream fungal isolates in paediatric
More informationInvasive Fungal Infections in Solid Organ Transplant Recipients
Outlines Epidemiology Candidiasis Aspergillosis Invasive Fungal Infections in Solid Organ Transplant Recipients Hsin-Yun Sun, M.D. Division of Infectious Diseases Department of Internal Medicine National
More informationAntifungal Susceptibility of Bloodstream Candida Isolates in Pediatric Patients
ISSN: 2319-7706 Volume 4 Number 3 (2015) pp. 716-720 http://www.ijcmas.com Original Research Article Antifungal Susceptibility of Bloodstream Candida Isolates in Pediatric Patients Deepak Kumar 1, Sayan
More informationBSI. Candida auris: A globally emerging multidrug-resistant yeast 5/19/2017. First report of C. auris from Japan in 2009
5/9/7 BSI Candida auris: A globally emerging multidrug-resistant yeast Mycotic Diseases Branch DFWED Friday Seminar August 6, 6 National Center for Emerging and Zoonotic Infectious Diseases Division of
More informationEpidemiology and Outcomes of Candidaemia among Adult Patients Admitted at Hospital Universiti Sains Malaysia (HUSM): A 5-Year Review
Epidemiology and Outcomes of Candidaemia among Adult Patients Admitted at Hospital Universiti Sains Malaysia (HUSM): A 5-Year Review Haydar A a a Department of Internal Medicine, Kulliyyah of Medicine,
More informationJapan Antifungal Surveillance Program (1):
183 Japan Antifungal Surveillance Program (1): 2001 2002 1) 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) 11) 12) 1) 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) 11) 12) 16 9 14 16 10 12 2001 6 2002 3 2 11 576 fluconazole (FLCZ),
More informationon November 3, 2018 by guest
JOURNAL OF CLINICAL MICROBIOLOGY, June 2007, p. 1811 1820 Vol. 45, No. 6 0095-1137/07/$08.00 0 doi:10.1128/jcm.00134-07 Copyright 2007, American Society for Microbiology. All Rights Reserved. Multicenter
More informationThe incidence of invasive fungal infections
AN EPIDEMIOLOGIC UPDATE ON INVASIVE FUNGAL INFECTIONS * Michael A. Pfaller, MD ABSTRACT *Based on a presentation given by Dr Pfaller at a symposium held in conjunction with the 43rd Interscience Conference
More informationSCY-078 ECMM Symposium Cologne, Germany October 2017
A New Path for Antifungal Treatments SCY-078 ECMM Symposium Cologne, Germany October 2017 David Angulo, M.D. Chief Medical Officer SCYNEXIS at a Glance Company created in 2000 Spin-off of Sanofi, initially
More informationSensitivity of Candida albicans isolates to caspofungin comparison of microdilution method and E-test procedure
Basic research Sensitivity of Candida albicans isolates to caspofungin comparison of microdilution method and E-test procedure Anna Serefko, Anna Malm Department of Pharmaceutical Microbiology, Medical
More informationAntifungal Therapy in Leukemia Patients
Antifungal Therapy in Leukemia Patients UPDATE ECIL 4, 6 September 2011 Raoul Herbrecht, Ursula Flückiger, Bertrand Gachot, Patricia Ribaud, Anne Thiebaut, Catherine Cordonnier UPDATE ECIL 4, 2011 UPDATE
More informationUse of the VITEK 2 system to identify and test the antifungal susceptibility of clinically relevant yeast species
Brazilian Journal of Microbiology 44, 4, 1257-1266 (2013) ISSN 1678-4405 Copyright 2013, Sociedade Brasileira de Microbiologia www.sbmicrobiologia.org.br Research Paper Use of the VITEK 2 system to identify
More informationEpidemiology and antifungal susceptibility of candidemia isolates of non-albicans Candida species from cancer patients
OPEN (2017) 6, e87; doi:10.1038/emi.2017.74 www.nature.com/emi ORIGINAL ARTICLE Epidemiology and antifungal susceptibility of candidemia isolates of non-albicans Candida species from cancer patients Ping-Feng
More informationRezafungin: A Novel Echinocandin. Taylor Sandison, MD MPH Chief Medical Officer ISHAM- Amsterdam July 2, 2018
: A Novel Echinocandin Taylor Sandison, MD MPH Chief Medical Officer ISHAM- Amsterdam July 2, 2018 Disclosures Dr. Sandison is an employee of and stockholder in Cidara Therapeutics. Cidara Pipeline Program
More informationMethods for colistin testing What works and what does not? Erika Matuschek, Ph D EUCAST Development Laboratory, EDL
Methods for colistin testing What works and what does not? Erika Matuschek, Ph D EUCAST Development Laboratory, EDL 3 rd joint meeting on AMR in Salmonella and Campylobacter, Copenhagen 7 April 2017 Antimicrobial
More informationCorrelation of the MIC and Dose/MIC Ratio of Fluconazole to the Therapeutic Response of Patients with Mucosal Candidiasis and Candidemia
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, Oct. 2007, p. 3599 3604 Vol. 51, No. 10 0066-4804/07/$08.00 0 doi:10.1128/aac.00296-07 Copyright 2007, American Society for Microbiology. All Rights Reserved. Correlation
More informationWhen is failure failure?
When is failure failure? Bart-Jan Kullberg, M.D. Radboud University Nijmegen The Netherlands The ICU patient with candidemia!! Female, 39 years old!! Multiple abdominal surgeries for Crohn's disease!!
More informationNew Options for Prevention & Treatment of Invasive Fungal Infections
New Options for Prevention & Treatment of Invasive Fungal Infections Taylor Sandison, MD, MPH Chief Medical Officer Cidara Therapeutics, Inc. HTIDE 2018, Venice Cidara Pipeline Program Indication Discovery
More informationData Mining Validation of Fluconazole Breakpoints Established by the European Committee on Antimicrobial Susceptibility Testing
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, July 2009, p. 2949 2954 Vol. 53, No. 7 0066-4804/09/$08.00 0 doi:10.1128/aac.00081-09 Copyright 2009, American Society for Microbiology. All Rights Reserved. Data
More informationThis is an open access article. Unrestricted non-commercial use is permitted provided the original work is properly cited.
Clinical Medicine Insights: Therapeutics Original Research Open Access Full open access to this and thousands of other papers at http://www.la-press.com. Impact of the New Clinical Breaking Points Proposed
More informationCandida auris: an Emerging Hospital Infection
National Center for Emerging and Zoonotic Infectious Diseases Candida auris: an Emerging Hospital Infection Paige Armstrong MD MHS Epidemic Intelligence Service Officer Mycotic Diseases Branch Association
More informationUse of Antifungal Drugs in the Year 2006"
Use of Antifungal Drugs in the Year 2006" Jose G. Montoya, MD Associate Professor of Medicine Associate Chief for Clinical Affairs Division of Infectious Diseases Stanford University School of Medicine
More informationNew triazoles and echinocandins: mode of action, in vitro activity and mechanisms of resistance
For reprint orders, please contact reprints@expert-reviews.com New triazoles and echinocandins: mode of action, in vitro activity and mechanisms of resistance Expert Rev. Anti Infect. Ther. 7(8), 981 998
More informationReceived 22 November 2007/Returned for modification 29 December 2007/Accepted 12 January 2008
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, Apr. 2008, p. 1396 1400 Vol. 52, No. 4 0066-4804/08/$08.00 0 doi:10.1128/aac.01512-07 Copyright 2008, American Society for Microbiology. All Rights Reserved. In Vitro
More informationMultilaboratory Testing of Two-Drug Combinations of Antifungals against Candida albicans, Candida glabrata, and Candida parapsilosis
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, Apr. 2011, p. 1543 1548 Vol. 55, No. 4 0066-4804/11/$12.00 doi:10.1128/aac.01510-09 Copyright 2011, American Society for Microbiology. All Rights Reserved. Multilaboratory
More informationAntifungal Treatment in Neonates
Antifungal Treatment in Neonates Irja Lutsar University of Tartu, Estonia Lisbon, 12. October 2015 Prevalence of invasive fungal infections in NeoINN database 2005-2014 UK; 2012-2014 Estonia & Greece 1
More informationAntifungal Activity of Voriconazole on Local Isolates: an In-vitro Study
Original Article Philippine Journal of OPHTHALMOLOGY Antifungal Activity of Voriconazole on Local Isolates: an In-vitro Study Karina Q. De Sagun-Bella, MD, 1 Archimedes Lee D. Agahan, MD, 1 Leo DP. Cubillan,
More informationSYNERGISTIC ACTIVITIES OF TWO PROPOLIS WITH AMPHOTERICIN B AGAINST SOME AZOLE-RESISTANT CANDIDA STRAINS. PART II
SYNERGISTIC ACTIVITIES OF TWO PROPOLIS WITH AMPHOTERICIN B AGAINST SOME AZOLE-RESISTANT CANDIDA STRAINS. PART II DURAN NIZAMI 1, MUZ MUSTAFA 2, DURAN GULAY GULBOL 3, OZER BURCIN 1, ONLEN YUSUF 4 1 Mustafa
More informationSolid organ transplant patients
M.6 Meet-the-expert sessions Solid organ transplant patients Martin Iversen, Denmark José M. Aguado, Spain Copenhagen, Sunday 13 October 2013 Conflict of interest disclosure In the past 5 years, J.M.A.
More informationSUSCEPTIBILITY TEST FOR FUNGI: CLINICAL AND LABORATORIAL CORRELATIONS IN MEDICAL MYCOLOGY
Rev. Inst. Med. Trop. Sao Paulo 57(Suppl. 19):57-64, September, 2015 http://dx.doi.org/10.1590/s0036-46652015000700011 SUSCEPTIBILITY TEST FOR FUNGI: CLINICAL AND LABORATORIAL CORRELATIONS IN MEDICAL MYCOLOGY
More informationEvaluation of aminocandin and caspofungin against Candida glabrata including isolates with reduced caspofungin susceptibility
Journal of Antimicrobial Chemotherapy (2008) 62, 1094 1100 doi:10.1093/jac/dkn304 Advance Access publication 25 July 2008 Evaluation of aminocandin and caspofungin against Candida glabrata including isolates
More informationRapid Species Identification and Antifungal Susceptibility Testing of Candida Isolated from Different Hospital Acquired Infections by VITEK 2 System
International Journal of Current Microbiology and Applied Sciences ISSN: 2319-7706 Volume 6 Number 11 (2017) pp. 764-772 Journal homepage: http://www.ijcmas.com Original Research Article https://doi.org/10.20546/ijcmas.2017.611.090
More informationClinical Considerations in the Management of Systemic Fungal Infections. Conducted during the 41 st ASHP Midyear Clinical Meeting Anaheim, California
Clinical Considerations in the Management of Systemic Fungal Infections Conducted during the 41 st ASHP Midyear Clinical Meeting Anaheim, California CONTINUING EDUCATION ACCREDITATION The American Society
More informationUpdate on Candida Infection Nov. 2010
Update on Candida Infection Nov. 2010 Gary Wong Pharmacy Clinical site leader University Health Network Course coordinator University of Toronto Goals What is an yeast infection Risk factors for yeast
More information