title: Epidemiologic cutoff values for triazole drugs in Cryptococcus gattii: correlation of molecular type and in vitro susceptibility.
abstract: Cryptococcus gattii causes infection in tropical and subtropical regions worldwide but has garnered increased attention since its 1999 emergence in North America. C. gattii can be divided into 4 molecular types that may represent cryptic species. Recent evidence has shown that azole antifungal MIC values differ among these molecular types. We tested a large collection of C. gattii isolates for susceptibility to 4 azole drugs. We found that isolates of molecular type VGII have the highest geometric mean (GM) fluconazole MIC values (8.6 μg/mL), while isolates of molecular type VGI have the lowest (1.7 μg/mL). For fluconazole, itraconazole, and voriconazole GM MIC values, VGI < VGIII < VGIV < VGII. The GM MIC values for posaconazole were similarly represented across molecular types, with the exception that VGII < VGIII and VGIV. We used the MIC values to establish preliminary epidemiologic cutoff values for each azole and molecular type of C. gattii.
authors.affiliation: Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. gyi2@cdc.gov
authors.forename: Shawn R
authors.initials: SR
authors.lastname: Lockhart
authors.forename: Naureen
authors.initials: N
authors.lastname: Iqbal
authors.forename: Carol B
authors.initials: CB
authors.lastname: Bolden
authors.forename: Emilio E
authors.initials: EE
authors.lastname: DeBess
authors.forename: Nicola
authors.initials: N
authors.lastname: Marsden-Haug
authors.forename: Ron
authors.initials: R
authors.lastname: Worhle
authors.forename: Rameshwari
authors.initials: R
authors.lastname: Thakur
authors.forename: Julie R
authors.initials: JR
authors.lastname: Harris
mesh_terms: D000818:Animals; D000935:Antifungal Agents / Q000494:pharmacology*; D003453:Cryptococcosis / Q000453:epidemiology* / Q000382:microbiology*; D056285:Cryptococcus gattii / Q000187:drug effects* / Q000235:genetics*; D006801:Humans; D008826:Microbial Sensitivity Tests / Q000379:methods; D058889:Molecular Typing / Q000379:methods*; D016533:Mycological Typing Techniques / Q000379:methods; D018709:Statistics, Nonparametric; D014230:Triazoles / Q000494:pharmacology*
chemical_list: D000935:Antifungal Agents; D014230:Triazoles