Cited by 129Antifungal resistance and susceptibilityBacterial Identification and Susceptibility TestingFungal Plant Pathogen Control

Breakpoints for antifungal agents: An update from EUCAST focussing on echinocandins against Candida spp. and triazoles against Aspergillus spp.

Arendrup, Maiken C., Cuenca-Estrella, Manuel, Lass-Flörl, Cornelia, Hope, William W.·2013·Drug Resistance Updates

Abstract

Candida and Aspergillus infections have emerged as significant pathogens in recent decades. During this same time, broad spectrum triazole and echinocandin antifungal agents have been developed and increasingly used. One consequence of widespread use is leading to the emergence of mutants with acquired resistance mutations. Therefore, accurate susceptibility testing and appropriate clinical breakpoints for the interpretation of susceptibility results have become increasingly important. Here we review the underlying methodology by which breakpoints have been selected by EUCAST (European Committee on Antimicrobial Susceptibility Testing). Five parameters are evaluated: dosing regimens used; EUCAST MIC distributions from multiple laboratories, species and compound specific epidemiological cut off values (upper MIC limits of wild type isolates or ECOFFs), pharmacokinetic/pharmacodynamic relationships and targets associated with outcome and finally clinical data by species and MIC when available. The general principles are reviewed followed by a detailed review of the individual aspects for Candida species and the three echinocandins and for Aspergillus and the three mould-active azoles. This review provides an update of the subcommittee on antifungal susceptibility testing (AFST) of the EUCAST methodology and summarises the current EUCAST breakpoints for Candida and Aspergillus. Recommendations about applicability of antifungal susceptibility testing in the routine setting are also included.

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Crossref · 10.1016/j.drup.2014.01.001

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Authors
Arendrup, M. C., Cuenca-Estrella, M., Lass-Flörl, C., & Hope, W. W.
Affiliations
  • Statens Serum Institut (DK)
  • University of Liverpool (GB)
Corresponding author
Arendrup, Maiken C.
Venue
Drug Resistance Updates
Publisher
Elsevier BV
Published
2013-12
Volume
16
Issue
6
Pages
81-95
ISSN
1368-7646 (ISSN-L)
OpenAlex
W2017430996
Cited by
129
References
133
Citations by year
2026: 2 · 2025: 5 · 2024: 3 · 2023: 7 · 2022: 6 · 2021: 10 · 2020: 10 · 2019: 9 · 2018: 11 · 2017: 15 · 2016: 19 · 2015: 21 · 2014: 10 · 2012: 1
FWCI
2.16
Type
journal article
Language
en
Open access
closed
Locations
  • Drug Resistance Updates (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health
  • National Institute for Health and Care Research
Topics
  • Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Bacterial Identification and Susceptibility Testing
  • Life Sciences › Agricultural and Biological Sciences › Ecology, Evolution, Behavior and Systematics › Fungal Plant Pathogen Control
Keywords
antifungal susceptibility breakpoints, EUCAST, echinocandins, triazoles, Candida, Aspergillus, epidemiological cut-off values, antifungal resistance, susceptibility testing, pharmacokinetic-pharmacodynamic relationship, dosing regimen
MeSH terms
Animals, Antifungal Agents, Aspergillosis, Aspergillus, Candida, Candidiasis, Humans, Microbial Sensitivity Tests, Triazoles, Drug Resistance, Fungal, Echinocandins

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