Real-world experience with echinocandin MICs against Candida species in a multicenter study of hospitals that routinely perform susceptibility testing of bloodstream isolates

Eschenauer, Gregory A.; Nguyen, M. Hong; Shoham, Shmuel; Vazquez, Jose A.; Morris, Arthur J.; Pasculle, William A.; Kubin, Christine J.; Klinker, Kenneth P.; Carver, Peggy L.; Hanson, Kimberly E.; Chen, Sharon; Lam, Simon W.; Potoski, Brian A.; Clarke, Lloyd G.; Shields, Ryan K.; Clancy, Cornelius J.

doi:10.1128/aac.02163-13

Cited by 61Antifungal resistance and susceptibilityYeasts and Rust Fungi StudiesBacterial Identification and Susceptibility Testing

Real-world experience with echinocandin MICs against Candida species in a multicenter study of hospitals that routinely perform susceptibility testing of bloodstream isolates

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Eschenauer, Gregory A., Nguyen, M. Hong, Shoham, Shmuel, Vazquez, Jose A., Morris, Arthur J., Pasculle, William A., Kubin, Christine J., Klinker, Kenneth P. +8 more·2014·Antimicrobial Agents and Chemotherapy

DOI 10.1128/aac.02163-13PMC PMC4023707

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Abstract

Reference broth microdilution methods of Candida echinocandin susceptibility testing are limited by interlaboratory variability in caspofungin MICs. Recently revised Clinical and Laboratory Standards Institute (CLSI) breakpoint MICs for echinocandin nonsusceptibility may not be valid for commercial tests employed in hospital laboratories. Indeed, there are limited echinocandin susceptibility testing data from hospital laboratories. We conducted a multicenter retrospective study of 9 U.S., Australian, and New Zealand hospitals that routinely tested Candida bloodstream isolates for echinocandin susceptibility from 2005 to 2013. Eight hospitals used Sensititre YeastOne assays. The Candida spp. were C. albicans (n=1,067), C. glabrata (n=911), C. parapsilosis (n=476), C. tropicalis (n=185), C. krusei (n=104), and others (n=154). Resistance and intermediate rates were ≤1.4% and ≤3%, respectively, for each echinocandin against C. albicans, C. parapsilosis, and C. tropicalis. Resistance rates among C. glabrata and C. krusei isolates were ≤7.5% and ≤5.6%, respectively. Caspofungin intermediate rates among C. glabrata and C. krusei isolates were 17.8% and 46.5%, respectively, compared to ≤4.3% and ≤4.4% for other echinocandins. Using CLSI breakpoints, 18% and 19% of C. glabrata isolates were anidulafungin susceptible/caspofungin nonsusceptible and micafungin susceptible/caspofungin nonsusceptible, respectively; similar discrepancies were observed for 38% and 39% of C. krusei isolates. If only YeastOne data were considered, interhospital modal MIC variability was low (within 2 doubling dilutions for each agent). In conclusion, YeastOne assays employed in hospitals may reduce the interlaboratory variability in caspofungin MICs against Candida species that are observed between reference laboratories using CLSI broth microdilution methods. The significance of classifying isolates as caspofungin intermediate and anidulafungin/micafungin susceptible will require clarification in future studies.

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Caspofungin is unreliable for MIC determination due to high interlaboratory variability.
“Caspofungin has been found to be unreliable for MIC determination due to high interlaboratory variability [33,34,35,36].”
From Treatment of Invasive Candidiasis: A Narrative Review (2018) · cites this paper as [35]

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Authors: Eschenauer, G. A., Nguyen, M. H., Shoham, S., Vazquez, J. A., Morris, A. J., Pasculle, W. A., Kubin, C. J., Klinker, K. P., Carver, P. L., Hanson, K. E., Chen, S., Lam, S. W., Potoski, B. A., Clarke, L. G., Shields, R. K., & Clancy, C. J.
Affiliations: University of Pittsburgh Medical Center (US)
University of Pittsburgh (US)
Johns Hopkins University (US)
Henry Ford Hospital, Detroit, Michigan, USA
Auckland City Hospital (NZ)
NewYork–Presbyterian Hospital (US)
UF Health Shands Hospital (US)
University of Michigan (US)
University of Utah (US)
Westmead Hospital (AU)
Cleveland Clinic (US)
ORCID: Eschenauer, Gregory A.
Nguyen, M. Hong
Shoham, Shmuel
Morris, Arthur J.
Kubin, Christine J.
Klinker, Kenneth P.
Carver, Peggy L.
Hanson, Kimberly E.
Lam, Simon W.
Shields, Ryan K.
Clancy, Cornelius J.
Venue: Antimicrobial Agents and Chemotherapy
Publisher: American Society for Microbiology
Published: 2014-04
Volume: 58
Issue: 4
Pages: 1897-1906
ISSN: 0066-4804 (ISSN-L)
1098-6596
DOI: 10.1128/aac.02163-13
PMC: PMC4023707
OpenAlex: W2109261304
Cited by: 61
References: 18
Citations by year: 2026: 1 · 2025: 1 · 2024: 1 · 2023: 1 · 2022: 2 · 2021: 1 · 2020: 3 · 2019: 4 · 2018: 7 · 2017: 4 · 2016: 11 · 2015: 11 · 2014: 14
FWCI: 9.34
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: journals.asm.org/non-commercial-tdm-license (tdm)
Locations: Antimicrobial Agents and Chemotherapy (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health (KL2TR000146)
National Center for Advancing Translational Sciences
Topics: Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Yeasts and Rust Fungi Studies
Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Bacterial Identification and Susceptibility Testing
Keywords: echinocandin susceptibility, caspofungin, anidulafungin, micafungin, Candida glabrata, Candida krusei, Candida albicans, Candida parapsilosis, Candida tropicalis, antifungal resistance, CLSI breakpoints, inter-laboratory variability
MeSH terms: Caspofungin, Micafungin, Anidulafungin, Antifungal Agents, Candida, Humans, Microbial Sensitivity Tests, Echinocandins, Lipopeptides

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Real-world experience with echinocandin MICs against Candida species in a multicenter study of hospitals that routinely perform susceptibility testing of bloodstream isolates

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