title: Antifungal susceptibilities of non-Aspergillus filamentous fungi causing invasive infection in Australia: support for current antifungal guideline recommendations.
abstract: Antifungal susceptibilities of non-Aspergillus filamentous fungal pathogens cannot always be inferred from their identification. Here we determined, using the Sensititre(®) YeastOne(®) YO10 panel, the in vitro activities of nine antifungal agents against 52 clinical isolates of emergent non-Aspergillus moulds representing 17 fungal groups in Australia. Isolates comprised Mucorales (n = 14), Scedosporium/Lomentospora spp. (n = 18) and a range of hyaline hyphomycetes (n = 9) and other dematiaceous fungi (n = 11). Excluding Verruconis gallopava, echinocandins demonstrated poor activity (MICs generally >8 mg/L) against these moulds. Lomentospora prolificans (n = 4) and Fusarium spp. (n = 6) demonstrated raised MICs to all antifungal drugs tested, with the lowest being to voriconazole and amphotericin B (AmB), respectively (geometric mean MICs of 3.4 mg/L and 2.2 mg/L, respectively). All Scedosporium apiospermum complex isolates (n = 14) were inhibited by voriconazole concentrations of ≤0.25 mg/L, followed by posaconazole and itraconazole at ≤1 mg/L. Posaconazole and AmB were the most active agents against the Mucorales, with MIC90 values of 1 mg/L and 2 mg/L, respectively, for Rhizopus spp. For dematiaceous fungi, all isolates were inhibited by itraconazole and posaconazole concentrations of ≤0.5 mg/L (MIC90, 0.12 mg/L and 0.25 mg/L, respectively), but voriconazole and AmB also had in vitro activity (MIC90, 0.5 mg/L and 1 mg/L, respectively). Differences in antifungal susceptibility within species and between species within genera support the need for testing individual patient isolates to guide therapy. The Sensititre(®) YeastOne(®) offers a practical alternative to the reference methodology for susceptibility testing of moulds.
authors: Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR-Pathology West, Westmead Hospital, Westmead, NSW, Australia. Electronic address: catriona.halliday@health.nsw.gov.au.
authors: Catriona L
authors: CL
authors: Halliday
authors: Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR-Pathology West, Westmead Hospital, Westmead, NSW, Australia; Marie Bashir Institute, University of Sydney, Westmead, NSW, Australia.
authors: Sharon C-A
authors: SC
authors: Chen
authors: National Mycology Reference Centre, SA Pathology, Adelaide, South Australia, Australia.
authors: Sarah E
authors: SE
authors: Kidd
authors: Department of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
authors: Sebastian
authors: S
authors: van Hal
authors: The Westmead Institute for Medical Research, The University of Sydney, Westmead, NSW, Australia.
authors: Belinda
authors: B
authors: Chapman
authors: Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Perth, WA, Australia; Department of Microbiology, PathWest Laboratory Medicine, Perth, WA, Australia; Department of Infectious Diseases, Fiona Stanley Hospital, Perth, WA, Australia; School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia.
authors: Christopher H
authors: CH
authors: Heath
authors: Department of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
authors: Andie
authors: A
authors: Lee
authors: Department of Infectious Diseases and Microbiology, Canberra Hospital, Australian National University Medical School, Canberra, ACT, Australia.
authors: Karina J
authors: KJ
authors: Kennedy
authors: Department of Infectious Diseases and Microbiology, Canberra Hospital, Australian National University Medical School, Canberra, ACT, Australia.
authors: Kathryn
authors: K
authors: Daveson
authors: Marie Bashir Institute, University of Sydney, Westmead, NSW, Australia; The Westmead Institute for Medical Research, The University of Sydney, Westmead, NSW, Australia.
authors: Tania C
authors: TC
authors: Sorrell
authors: Department of Infectious Diseases, Alfred Health, Monash University, Melbourne, VIC, Australia.
authors: C Orla
authors: CO
authors: Morrissey
authors: Department of Microbiology and Infectious Diseases, St Vincent's Hospital, Sydney, NSW, Australia.
authors: Deborah J
authors: DJ
authors: Marriott
authors: Department of Infectious Diseases, Peter MacCallum Cancer Centre, Victorian Infectious Diseases Service, Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia.
authors: Monica A
authors: MA
authors: Slavin
mesh_terms: D000935:Antifungal Agents / Q000494:pharmacology*; D001315:Australia; D005658:Fungi / Q000187:drug effects* / Q000302:isolation & purification*; D006801:Humans; D008826:Microbial Sensitivity Tests; D009181:Mycoses / Q000382:microbiology*
chemical_list: D000935:Antifungal Agents
keywords: Antifungal susceptibility; Non-Aspergillus moulds; Sensititre(®); YeastOne(®)