期刊
CLINICAL MICROBIOLOGY AND INFECTION
卷 26, 期 11, 页码 1464-1472出版社
ELSEVIER SCI LTD
DOI: 10.1016/j.cmi.2020.06.007
关键词
Amphotericin B; Aspergillus; Azoles; Breakpoint; Candida; Echinocandins; Intermediate; Resistant; Susceptible; Susceptible increased exposure
Background: EUCAST has revised the definition of the susceptibility category I from 'Intermediate' to 'Susceptible, Increased exposure'. This implies that I can be used where the drug concentration at the site of infection is high, either because of dose escalation or through other means to ensure efficacy. Consequently, I is no longer used as a buffer zone to prevent technical factors from causing misclassifications and discrepancies in interpretations. Instead, an Area of Technical Uncertainty (ATU) has been introduced for MICs that cannot be categorized without additional information as a warning to the laboratory that decision on how to act has to be made. To implement these changes, the EUCAST-AFST (Subcommittee on Antifungal Susceptibility Testing) reviewed all, and revised some, clinical antifungal breakpoints. Objectives: The aim was to present an overview of the current antifungal breakpoints and supporting evidence behind the changes. Sources: This document is based on the ten recently updated EUCAST rationale documents, clinical breakpoint and breakpoint ECOFF documents. Content: The following breakpoints (in mg/L) have been revised or established for Candida species: micafungin against C. albicans (ATU = 0.03); amphotericin B (S <=/> R = 1/1), fluconazole (S <=/> R = 2/4), itraconazole (S <=/> R = 0.06/0.06), posaconazole (S <=/> R = 0.06/0.06) and voriconazole (S <=/> R = 0.06/0.25) against C. dubliniensis; fluconazole against C. glabrata (S <=/> R = 0.001/16); and anidulafungin (S <=/> R = 4/4) and micafungin (S <=/> R = 2/2) against C. parapsilosis. For Aspergillus, new or revised breakpoints include itraconazole (ATU = 2) and isavuconazole against A. flavus (S <=/> R = 1/2, ATU = 2); amphotericin B (S <=/> R 1/4 1/1), isavuconazole (S <=/> R = 1/2, ATU = 2), itraconazole (S <=/> R = 1/1, ATU = 2), posaconazole (ATU = 0.25) and voriconazole (S <=/> R = 1/1, ATU = 2) against A. fumigatus; itraconazole (S <=/> R = 1/1, ATU = 2) and voriconazole (S <=/> R = 1/1, ATU = 2) against A. nidulans; amphotericin B against A. niger (S <=/> R = 1/1); and itraconazole (S <=/> R = 1/1, ATU = 2) and posaconazole (ATU = 0.25) against A. terreus. Implications: EUCAST-AFST has released ten new documents summarizing existing and new breakpoints and MIC ranges for control strains. A failure to adopt the breakpoint changes may lead to misclassifications and suboptimal or inappropriate therapy of patients with fungal infections. (c) 2020 Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases.
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