Objectives

To determine the Etest-based epidemiological cut-off values (ECVs) for antifungal agents against the most frequent yeast and Aspergillus fumigatus species isolated in 12 French hospitals.

Methods

For each antifungal agent, the Etest MICs in yeast and A. fumigatus isolates from 12 French laboratories were retrospectively collected from 2004 to 2018. The ECVs were then calculated using the iterative statistical method with a 97.5% cut-off.

Results

Forty-eight Etest ECVs were determined for amphotericin B, caspofungin, micafungin, anidulafungin, fluconazole, voriconazole, posaconazole and itraconazole, after pooling and analysing the MICs of 9654 Candida albicans, 2939 Candida glabrata SC, 1458 Candida parapsilosis SC, 1148 Candida tropicalis, 575 Candida krusei, 518 Candida kefyr, 241 Candida lusitaniae, 131 Candida guilliermondii and 1526 Aspergillus fumigatus species complex isolates. These ECVs were 100% concordant (identical or within one two-fold dilution) with the previously reported Etest-based ECVs (when available), and they were concordant in 76.1% of cases with the Clinical and Laboratory Standards Institute ECVs and in 81.6% of cases with the European Committee on Antimicrobial Susceptibility Testing ECVs.

Conclusions

On the basis of these and other previous results, we recommend the determination of method-dependent ECVs. Etest ECVs should not be used instead of breakpoints, but may be useful to identify non-wild-type isolates with potential resistance to antifungal agents, and to indicate that an isolate may not respond as expected to the standard treatment.

中文翻译：

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通过多中心研究确定假丝酵母中抗真菌药物的Etest流行病学临界值。和烟曲霉种复合体

目标

要确定针对12家法国医院中分离的最常见酵母和烟曲霉抗真菌药的基于Etest的流行病学临界值（ECV）。

方法

对于每种抗真菌剂，从2004年至2018年回顾性地收集了来自12个法国实验室的酵母和烟曲霉菌株中的Etest MIC 。然后使用迭代统计方法计算ECV，截止值为97.5％。

结果

四十八个Etest法的ECV测定两性霉素B，卡泊芬净，米卡芬净，阿尼芬净，氟康唑，伏立康唑，泊沙康唑和伊曲康唑，汇集和分析的9654个的MIC后白色念珠菌，2939光滑念珠菌SC，1458近平滑念珠菌SC，1148个热带假丝酵母， 575克鲁斯假丝酵母，518克菲假丝酵母，241卢西坦假丝酵母，131吉里蒙德假丝酵母和1526烟曲霉物种复杂的分离物。这些ECV与先前报道的基于Etest的ECV（如果可用）一致（100％一致或两倍稀释），在临床和实验室标准协会的ECV中，有76.1％与81.6％一致。欧洲抗菌药物敏感性测试委员会（ECV）的案例。

结论

根据这些以及其他先前的结果，我们建议确定方法相关的ECV。不应使用Etest ECV代替断点，而应用于鉴定对抗真菌剂具有潜在耐药性的非野生型分离株，并表明分离株可能不会对标准治疗产生预期的反应。