Fluconazole resistance is not a predictor of poor outcome in patients with cryptococcosis.
Cryptococcus
AIDS
fluconazole resistance
meningitis
Journal
Mycoses
ISSN: 1439-0507
Titre abrégé: Mycoses
Pays: Germany
ID NLM: 8805008
Informations de publication
Date de publication:
May 2019
May 2019
Historique:
received:
12
02
2018
revised:
07
08
2018
accepted:
30
08
2018
pubmed:
6
9
2018
medline:
21
5
2019
entrez:
6
9
2018
Statut:
ppublish
Résumé
Cryptococcus isolates with high MICs to fluconazole are increasingly reported, and a potential clinical impact has been advocated. However, there are different methods to evaluate fluconazole MICs and comparative analysis among such techniques and their comprehensive correlation with clinical outcome are not available. Over a 13-year period (2000-2013), fluconazole MICs were determined for 62 cryptococcal isolates recovered from 22 patients with cryptococcosis using CLSI M27-A3, EUCAST, E test and Sensititre YeastOne, simultaneously. The relationship between the fluconazole MICs and the clinical outcome at week 10 was assessed in patients who received fluconazole as induction or maintenance therapy (n = 16). The percentage of cryptococcal strains with MIC values ≥16 μg/mL according to different methods was CLSI 1.6%, EUCAST 16.1%, E test 31.6% and Sensititre YeastOne 53.2%. Among the 16 patients treated with fluconazole, no correlation between clinical outcome and any MIC value obtained with either method was observed. The only variable independently associated with a poor outcome was having a disseminated disease. There is a weak correlation between fluconazole MICs against Cryptococcus spp. as determined by CLSI, EUCAST, E test and Sensititre YeastOne. Neither procedure could predict the clinical outcome of patients with cryptococcosis receiving fluconazole-based therapy. With present methods, fluconazole resistance in Cryptococcus may be clinically misleading.
Sections du résumé
BACKGROUND
BACKGROUND
Cryptococcus isolates with high MICs to fluconazole are increasingly reported, and a potential clinical impact has been advocated. However, there are different methods to evaluate fluconazole MICs and comparative analysis among such techniques and their comprehensive correlation with clinical outcome are not available.
METHODS
METHODS
Over a 13-year period (2000-2013), fluconazole MICs were determined for 62 cryptococcal isolates recovered from 22 patients with cryptococcosis using CLSI M27-A3, EUCAST, E test and Sensititre YeastOne, simultaneously. The relationship between the fluconazole MICs and the clinical outcome at week 10 was assessed in patients who received fluconazole as induction or maintenance therapy (n = 16).
RESULTS
RESULTS
The percentage of cryptococcal strains with MIC values ≥16 μg/mL according to different methods was CLSI 1.6%, EUCAST 16.1%, E test 31.6% and Sensititre YeastOne 53.2%. Among the 16 patients treated with fluconazole, no correlation between clinical outcome and any MIC value obtained with either method was observed. The only variable independently associated with a poor outcome was having a disseminated disease.
CONCLUSIONS
CONCLUSIONS
There is a weak correlation between fluconazole MICs against Cryptococcus spp. as determined by CLSI, EUCAST, E test and Sensititre YeastOne. Neither procedure could predict the clinical outcome of patients with cryptococcosis receiving fluconazole-based therapy. With present methods, fluconazole resistance in Cryptococcus may be clinically misleading.
Substances chimiques
Antifungal Agents
0
Fluconazole
8VZV102JFY
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
441-449Subventions
Organisme : PROgrama MULtidisciplinar para la Gestión de Antifúngicos y la Reducción de Candidiasis Invasora PROMULGA II Project
Organisme : Instituto de Salud Carlos III Madrid Spain
Organisme : European Regional Development Fund (FEDER) "A way of making Europe"
ID : PI13/01148
Organisme : European Regional Development Fund (FEDER) "A way of making Europe"
ID : CM15/00181
Informations de copyright
© 2019 Blackwell Verlag GmbH.