title: Effect of Media Modified To Mimic Cystic Fibrosis Sputum on the Susceptibility of Aspergillus fumigatus, and the Frequency of Resistance at One Center.
abstract: Studies of cystic fibrosis (CF) patient exacerbations attributed toPseudomonas aeruginosainfection have indicated a lack of correlation of outcome within vitrosusceptibility results. One explanation is that the media used for testing do not mimic the airway milieu, resulting in incorrect conclusions. Therefore, media have been devised to mimic CF sputum.Aspergillus fumigatusis the leading fungal pathogen in CF, and susceptibility testing is also used to decide therapeutic choices. We assessed whether media designed to mimic CF sputa would give different fungal susceptibility results than those of classical methods, assaying voriconazole, the most utilized anti-Aspergillusdrug in this setting, and 30 CFAspergillusisolates. The frequency of marked resistance (defined as an MIC of >4 μg/ml) in our CF unit by classical methods is 7%. Studies performed with classical methods and with digested sputum medium, synthetic sputum medium, and artificial sputum medium revealed prominent differences inAspergillussusceptibility results, as well as growth rate, with each medium. Clinical correlative studies are required to determine which results are most useful in predicting outcome. Comparison of MICs with non-CF isolates also indicated the CF isolates were generally more resistant.
authors.affiliation: Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA California Institute for Medical Research, San Jose, California, USA stevens@stanford.edu.
authors.forename: David A
authors.initials: DA
authors.lastname: Stevens
authors.affiliation: Division of Pulmonology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Moss
authors.affiliation: Division of Pulmonology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Cathy
authors.initials: C
authors.lastname: Hernandez
authors.affiliation: Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA California Institute for Medical Research, San Jose, California, USA.
authors.forename: Karl V
authors.initials: KV
authors.lastname: Clemons
authors.affiliation: California Institute for Medical Research, San Jose, California, USA.
authors.forename: Marife
authors.initials: M
authors.lastname: Martinez
mesh_terms: D000935:Antifungal Agents / Q000494:pharmacology*; D001228:Aspergillosis / Q000382:microbiology; D001232:Aspergillus fumigatus / Q000187:drug effects / Q000254:growth & development; D040761:Biomimetic Materials / Q000737:chemistry / Q000494:pharmacology*; D003550:Cystic Fibrosis / Q000382:microbiology / Q000473:pathology; D024881:Drug Resistance, Bacterial; D006801:Humans; D008826:Microbial Sensitivity Tests; D013183:Sputum / Q000737:chemistry*; D065819:Voriconazole / Q000494:pharmacology*
chemical_list: D000935:Antifungal Agents; D065819:Voriconazole
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