In vitro fluconazole and voriconazole susceptibilities of candida bloodstream isolates in korea: Use of the CLSI and EUCAST epidemiological cutoff values

Min Joong Jang, Jong Hee Shin, Wee Gyo Lee, Mi Na Kim, Kyungwon Lee, Hye Soo Lee, Mi Kyung Lee, Chulhun L. Chang, Hee Chang Jang, Eun Song Song, Soo Hyun Kim, Myung Geun Shin, Soon Pal Suh, Dong Wook Ryang

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Abstract

Background: At present, the clinical breakpoints (CBPs) of both fluconazole and voriconazole are available only for 3 common Candida species in the Clinical and Laboratory Standards Institute (CLSI) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST) methods. Epidemiological cutoff values (ECVs) were recently applied to both methods to detect the emergence of acquired resistance (i.e., non-wild-type isolates) among 5 common Candida species. Methods: We performed a nationwide study to determine the fluconazole and voriconazole susceptibility of Candida bloodstream isolates (BSIs) using both the CLSI and EUCAST methods. A total of 423 BSIs of 5 Candida species were collected from 8 hospitals. The azole susceptibilities were assessed on the basis of the species-specific CBPs and ECVs. Results: Of the 341 BSIs of 3 common Candida species (i.e., C. albicans, C. tropicalis, and C. parapsilosis), 0.3% and 0.9%, 0.0% and 1.5% of isolates were categorized as fluconazole and voriconazole resistant according to the CLSI and EUCAST CBPs, respectively. Of 423 total BSIs, 1.4% and 2.6% had fluconazole minimum inhibitory concentrations (MICs) exceeding the ECVs according to the CLSI and EUCAST, respectively; 1.0% and 2.1% had voriconazole MICs exceeding the ECVs according to the CLSI and EUCAST, respectively. Categorical agreement between the methods using ECVs was 98.3% for fluconazole and 98.3% for voriconazole. Conclusions: The EUCAST and CLSI methods using ECVs provide highly concordant results. Moreover, non-wild-type isolates with possibly acquired azole resistance were rare among the BSIs of 5 common Candida species in Korea.

Original languageEnglish
Pages (from-to)167-173
Number of pages7
JournalAnnals of laboratory medicine
Volume33
Issue number3
DOIs
Publication statusPublished - 2013

All Science Journal Classification (ASJC) codes

  • Clinical Biochemistry
  • Biochemistry, medical

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    Jang, M. J., Shin, J. H., Lee, W. G., Kim, M. N., Lee, K., Lee, H. S., Lee, M. K., Chang, C. L., Jang, H. C., Song, E. S., Kim, S. H., Shin, M. G., Suh, S. P., & Ryang, D. W. (2013). In vitro fluconazole and voriconazole susceptibilities of candida bloodstream isolates in korea: Use of the CLSI and EUCAST epidemiological cutoff values. Annals of laboratory medicine, 33(3), 167-173. https://doi.org/10.3343/alm.2013.33.3.167