Do In Vitro Susceptibility Data Predict the Microbiologic Response to Amphotericin B? Results of a Prospective Study of Patients with Candida Fungemia

Nguyen, M. Hong; Clancy, Cornelius J.; Yu, Victor L.; Yu, Yue C.; Morris, Arthur J.; Snydman, David R.; Sutton, Deanna A.; Rinaldi, Michael G.

doi:10.1086/514193

Cited by 219Antifungal resistance and susceptibilityFungal Infections and StudiesFungal Plant Pathogen Control

Do In Vitro Susceptibility Data Predict the Microbiologic Response to Amphotericin B? Results of a Prospective Study of Patients with Candida Fungemia

Nguyen, M. Hong, Clancy, Cornelius J., Yu, Victor L., Yu, Yue C., Morris, Arthur J., Snydman, David R., Sutton, Deanna A., Rinaldi, Michael G.·1998·The Journal of Infectious Diseases

DOI 10.1086/514193

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Abstract

Outcome for 105 patients with candidemia treated with amphotericin B was correlated with amphotericin B in vitro susceptibility results. Thirty-three patients had microbiologic failure, which was defined as persistence of Candida in the bloodstream despite > or = 3 days of amphotericin B. Amphotericin B minimum inhibitory concentrations (MICs) were determined by the National Committee for Clinical Laboratory Standards methodology. After determination of MICs, the minimal lethal concentrations (MLCs) were determined. The isolates tested yielded a narrow range of amphotericin B MICs (0.06-2 microg/mL); only 5% (5/105) exhibited MICs > or = 1 microg/mL. The MLC range, on the other hand, was significantly broader (0.125 to > 16 microg/mL); 24% (25/105) exhibited MLCs > or = 1 microg/mL. The strongest predictor for microbiologic failure was 48-h MLC (P < .001), followed by 24-h MLC (P = .03) and 48-h MIC (P = .11). A resistant break point for amphotericin B of > 1 microg/mL for MLC and > or = 1 microg/mL for MIC could be inferred from this study.

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Correlation between amphotericin B MIC values and clinical response has not been consistently established.
“Correlation between amphotericin B MIC values and clinical response has not been consistently established [60,61].”
From Treatment of Invasive Candidiasis: A Narrative Review (2018) · cites this paper as [61]
Variations of the M27-A2 methodology using different media, agar-based MIC methods, and measurements of minimum fungicidal concentrations appear to enhance detection of resistant isolates.
“Variations of the M27-A2 methodology using different media [6], agar-based MIC methods [12,35,36], and measurements of minimum fungicidal concentrations [11] appear to enhance detection of resistant isolates.”
From Guidelines for Treatment of Candidiasis (2004) · cites this paper as [11]
Not all C. lusitaniae isolates are resistant, but therapeutic failure of amphotericin B is well documented.
“Not all isolates are resistant [11,23,37], but therapeutic failure of amphotericin B is well documented [38].”
From Guidelines for Treatment of Candidiasis (2004) · cites this paper as [11]
A growing body of data suggests that a nontrivial proportion of the isolates of C. glabrata and C. krusei may be resistant to amphotericin B.
“Third, a growing body of data suggests that a nontrivial proportion of the isolates of C. glabrata and C. krusei may be resistant to amphotericin B [4,11,[20][21][22].”
From Guidelines for Treatment of Candidiasis (2004) · cites this paper as [11]

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Authors: Nguyen, M. H., Clancy, C. J., Yu, V. L., Yu, Y. C., Morris, A. J., Snydman, D. R., Sutton, D. A., & Rinaldi, M. G.
Affiliations: Tufts Medical Center (US)
Corresponding author: Nguyen, M. Hong
ORCID: Nguyen, M. Hong
Clancy, Cornelius J.
Yu, Victor L.
Morris, Arthur J.
Snydman, David R.
Venue: The Journal of Infectious Diseases
Publisher: Oxford University Press (OUP)
Published: 1998-02
Volume: 177
Issue: 2
Pages: 425-430
ISSN: 0022-1899 (ISSN-L)
1537-6613
DOI: 10.1086/514193
OpenAlex: W2047133769
Cited by: 219
References: 10
Citations by year: 2025: 1 · 2024: 2 · 2023: 4 · 2022: 2 · 2021: 4 · 2020: 8 · 2019: 2 · 2018: 1 · 2017: 5 · 2015: 4 · 2014: 3 · 2013: 10 · 2012: 9
FWCI: 13.32
Type: journal article
Language: en
Open access: closed
Locations: The Journal of Infectious Diseases (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
Health Sciences › Medicine › Epidemiology › Fungal Infections and Studies
Life Sciences › Agricultural and Biological Sciences › Ecology, Evolution, Behavior and Systematics › Fungal Plant Pathogen Control
Keywords: amphotericin B, candidemia, Candida, antifungal susceptibility, minimum inhibitory concentration, minimal lethal concentration, antifungal resistance, resistance breakpoints, in vitro susceptibility testing
MeSH terms: Amphotericin B, Antifungal Agents, Candida, Candidiasis, Drug Resistance, Microbial, Humans, Microbial Sensitivity Tests, Predictive Value of Tests, Sensitivity and Specificity, Fungemia, Treatment Outcome, Treatment Failure

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Do In Vitro Susceptibility Data Predict the Microbiologic Response to Amphotericin B? Results of a Prospective Study of Patients with Candida Fungemia

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