Rapid antifungal susceptibility determination for yeast isolates by use of Etest performed directly on blood samples from patients with fungemia.
We prospectively determined the antifungal susceptibility of yeast isolates causing fungemia using the Etest on direct blood samples (195 prospectively collected and 133 laboratory prepared). We compared the Etest direct (24 h of incubation) with CLSI M27-A3 and the standard Etest methodologies for fluconazole, voriconazole, posaconazole, isavuconazole, caspofungin, and amphotericin B. Strains were classified as susceptible, resistant, or nonsusceptible using CLSI breakpoints (voriconazole breakpoints were used for posaconazole and isavuconazole). Categorical errors between Etest direct and CLSI M27-A3 for azoles were mostly minor. No errors were detected for caspofungin, and high percentages of major errors were detected for amphotericin B. For the azoles, false susceptibility (very major errors) was found in only two (0.6%) isolates (Candida tropicalis and C. glabrata). False resistance (major errors) was detected in 46 (14%) isolates for the three azoles (in 23 [7%] after excluding posaconazole). Etest direct of posaconazole yielded a higher number of major errors than the remaining azoles, especially for C. glabrata, Candida spp., and other yeasts. Excluding C. glabrata, Candida spp., and other yeasts, the remaining species did not yield major errors. Etest direct for fluconazole, voriconazole, isavuconazole, and caspofungin shows potential as an alternative to the CLSI M27-A3 procedure for performing rapid antifungal susceptibility tests on yeast isolates from patients with fungemia. Etest direct is a useful tool to screen for the presence of azole-resistant and caspofungin-nonsusceptible strains.
Guinea
Jesús
J
Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain. jguineaortega@yahoo.es
Recio
Sandra
S
Escribano
Pilar
P
Torres-Narbona
Marta
M
Peláez
Teresa
T
Sánchez-Carrillo
Carlos
C
Rodríguez-Créixems
Marta
M
Bouza
Emilio
E
D000935:Antifungal Agents / Q000494:pharmacology*; D003951:Diagnostic Errors / Q000706:statistics & numerical data; D016469:Fungemia / Q000382:microbiology*; D006801:Humans; D008826:Microbial Sensitivity Tests / Q000379:methods; D015003:Yeasts / Q000187:drug effects*
D000935:Antifungal Agents
J Clin Microbiol. 2009 Sep;47(9):2766-71
19571029
Diagn Microbiol Infect Dis. 1994 Oct;20(2):81-6
7867309
Clin Infect Dis. 2006 Jul 1;43(1):25-31
16758414
J Clin Microbiol. 2006 Mar;44(3):819-26
16517860
Clin Microbiol Rev. 2007 Jan;20(1):133-63
17223626
Antimicrob Agents Chemother. 2002 Aug;46(8):2477-81
12121921
J Clin Microbiol. 2005 Apr;43(4):1829-35
15815004
Clin Microbiol Rev. 2006 Apr;19(2):435-47
16614256
J Clin Microbiol. 2003 May;41(5):1875-80
12734220
Antimicrob Agents Chemother. 2005 Sep;49(9):3640-5
16127033
Antimicrob Agents Chemother. 2008 Apr;52(4):1396-400
18212101
Antimicrob Agents Chemother. 2003 May;47(5):1647-51
12709335
Clin Infect Dis. 2007 Feb 1;44(3):382-7
17205445
J Antimicrob Chemother. 2007 Sep;60(3):459-60
17646200
J Hosp Infect. 2002 Apr;50(4):243-60
12014897
Curr Infect Dis Rep. 2006 Nov;8(6):427-33
17064635
Eur J Clin Microbiol Infect Dis. 2007 Aug;26(8):541-7
17569999
Antimicrob Agents Chemother. 2008 Nov;52(11):4175-7
18809944
J Clin Microbiol. 2002 Mar;40(3):918-21
11880416
Antimicrob Agents Chemother. 2006 Apr;50(4):1287-92
16569842
J Clin Microbiol. 2001 Apr;39(4):1328-33
11283051
Diagn Microbiol Infect Dis. 2007 Jun;58(2):211-6
17368806
Future Microbiol. 2008 Dec;3(6):603-15
19072177
J Clin Microbiol. 2008 Aug;46(8):2620-9
18579718
Infect Control Hosp Epidemiol. 2008 Oct;29(10):978-80
18715153