Use of Fluconazole as a Surrogate Marker To Predict Susceptibility and Resistance to Voriconazole among 13,338 Clinical Isolates of Candida spp. Tested by Clinical and Laboratory Standards Institute-Recommended Broth Microdilution Methods
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Clinical laboratories frequently face the problem of delayed availability of commercially prepared approved reagents for performing susceptibility testing of new antimicrobials. Although this problem is encountered more often with antibacterial agents, it is also an issue with antifungal agents. A current example is voriconazole, a new triazole antifungal with an expanded spectrum and potency against Candida spp., Aspergillus spp., and other opportunistic fungal pathogens. The present study addresses the use of fluconazole as a surrogate marker to predict the susceptibility of Candida spp. to voriconazole. Reference broth microdilution MIC results for 13,338 strains of Candida spp. isolated from more than 200 medical centers worldwide were used. Voriconazole MICs and interpretive categories (susceptible, ≤1 μg/ml; susceptible dose dependent, 2 μg/ml; resistant, ≥4 μg/ml) were compared with those of fluconazole by regression statistics and error rate bounding analyses. For all 13,338 isolates, the absolute categorical agreement was 91.6% (false susceptible or very major error [VME], 0.0%). Since voriconazole is 16- to 32-fold more potent than fluconazole, the performance of fluconazole as a surrogate marker for voriconazole susceptibility was improved by designating those isolates with fluconazole MICs of ≤32 μg/ml as being susceptible to voriconazole, resulting in a categorical agreement of 97% with 0.1% VME. Clinical laboratories performing antifungal susceptibility testing of fluconazole against Candida spp. can reliably use these results as surrogate markers until commercial FDA-approved voriconazole susceptibility tests become available.
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Variations in the structure of azoles are responsible for the cross-resistance patterns among Candida species.
“It appears that variations in the structure of azoles are responsible for the cross-resistance patterns among Candida species [92–94].”
From <i>Candida</i>Infections, Causes, Targets, and Resistance Mechanisms: Traditional and Alternative Antifungal Agents (2013) · cites this paper as [93]
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Hrabovský, V., Takáčová, V., Schréterová, E., Pastvová, L., Hrabovská, Z., Čurová, K., & Siegfried, L. (2017) · Folia Microbiologica · doi:10.1007/s12223-017-0525-8 · Cited by 10 · see citing works
Nett, J. E., & Andes, D. R. (2014) · ASM Press eBooks · doi:10.1128/9781555817176.ch22 · Cited by 10 · see citing works
New developments in the antifungal susceptibility testing of Candida
Pfaller, M. A. (2008) · Current Fungal Infection Reports · doi:10.1007/s12281-008-0019-x · Cited by 9 · see citing works
Self-citationDam characteristics associated with pre-weaning diarrhea in mink (Neovison vison)
Birch, J. M., Agger, J. F. G., Aalbæk, B., Struve, T., Hammer, A. S., & Jensen, H. E. (2018) · Acta veterinaria Scandinavica · doi:10.1186/s13028-018-0427-z · Cited by 8 · see citing works
Antifungal Susceptibility of Candida albicans Isolates at a Tertiary Care Hospital in Bulgaria
Hitkova, H. Y., Georgieva, D. S., Hristova, P. M., & Sredkova, M. (2019) · Jundishapur Journal of Microbiology · doi:10.5812/jjm.92079 · Cited by 8 · see citing works
Mechanisms of Resistance to Antifungal Agents
Perlin, D. S. (2015) · ASM Press eBooks · doi:10.1128/9781555817381.ch130 · Cited by 7 · see citing works
In vitroactivity of voriconazole against Mexican oral yeast isolates
Vargas, L. O. S., Eraso, E., Carrillo‐Muñoz, A. J., Aguirre, J. M., Gaitán-Cepeda, L. A., & Quindós, G. (2009) · Mycoses · doi:10.1111/j.1439-0507.2009.01702.x · Cited by 7 · see citing works
Shabeer, M., Barbosa, L. C. A., Karak, M., Coelho, A. C. S., & Takahashi, J. A. (2018) · Medicinal Chemistry Research · doi:10.1007/s00044-017-2126-0 · Cited by 5 · see citing works
SPECIES DISTRIBUTION AND ANTIFUNGAL SUSCEPTIBILITY OF YEASTS ISOLATED FROM VAGINAL MUCOSA
Moreira, D., Auler, M. E., Ruiz, L. D. S., da Silva, E. H., Hahn, R. C., & Paula, C. R. (2014) · Revista de Patologia Tropical / Journal of Tropical Pathology · doi:10.5216/rpt.v43i1.29371 · Cited by 6 · see citing works
Biographical Feature: Michael A. Pfaller, M.D
Moser, S. A. (2012) · Journal of Clinical Microbiology · doi:10.1128/jcm.03125-12 · Cited by 4 · see citing works
Prostatic Abscess With Candida glabrata Treated With Micafungin
Gupta, S., Liu-Young, G., Mahnensmith, R. L., & Topal, J. E. (2008) · Infectious Diseases in Clinical Practice · doi:10.1097/ipc.0b013e31816613f1 · Cited by 3 · see citing works
Jones, R. N., Castanheira, M., & Pfaller, M. A. (2010) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.00330-10 · Cited by 3 · see citing works
Self-citationDrug susceptibility of Candida isolated from the surfaces of mobile phones and hands
Kordecka, A., Krajewska-Kułak, E., Łukaszuk, C. R., Kraszyński, M., & Kraszyńska, B. (2017) · Progress in Health Sciences · doi:10.5604/01.3001.0010.1861 · Cited by 2 · see citing works
Antifungal Susceptibility of Non-albicans Candida Species in A Tertiary Care Hospital, Bulgaria
Hitkova, H. Y., Georgieva, D. S., Hristova, P. M., Marinova-Bulgaranova, T. V., Borisov, B. K., & Попов, В. Г. (2020) · Jundishapur Journal of Microbiology · doi:10.5812/jjm.101767 · Cited by 2 · see citing works
Andes, D. R., & Dismukes, W. E. (2010) · Springer eBooks · doi:10.1007/978-1-4419-6640-7_5 · Cited by 3 · see citing works
L’albumine endogène : un pouvoir anti-oxydant majeur
Mira, J. P. (2008) · Réanimation · doi:10.1016/s1624-0693(08)73934-3 · Cited by 1 · see citing works
Issues in Anti-infective Management
Forrest, G. N., & Kleinberg, M. E. (2009) · Humana Press eBooks · doi:10.1007/978-1-59745-415-5_13
Anidulafungine : une nouvelle option thérapeutique dans les candidoses systémiques
Lanternier, F., & Lortholary, O. (2010) · Médecine et Maladies Infectieuses · doi:10.1016/j.medmal.2009.12.002
Spectrum of Activity, Pharmacology, and Clinical Indications
Nett, J. E., & Andes, D. R. (2015)
- Authors
- Pfaller, M. A., Messer, S. A., Boyken, L., Rice, C., Tendolkar, S., Hollis, R. J., & Diekema, D. J.
- Affiliations
- University of Iowa (US)
- Venue
- Journal of Clinical Microbiology
- Publisher
- American Society for Microbiology
- Published
- 2007-01
- Volume
- 45
- Issue
- 1
- Pages
- 70-75
- ISSN
- 0095-1137 (ISSN-L)
- 1098-660X
- PMC
- PMC1828974
- OpenAlex
- W2148641130
- Cited by
- 77
- References
- 32
- Citations by year
- 2023: 1 · 2020: 2 · 2019: 3 · 2018: 3 · 2017: 2 · 2016: 1 · 2015: 7 · 2014: 8 · 2013: 4 · 2012: 7
- FWCI
- 5.37
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Journal of Clinical Microbiology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
- Funders
- Pfizer
- 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
- voriconazole, fluconazole, Candida, surrogate markers, antifungal susceptibility testing, triazole antifungals, minimum inhibitory concentration, very major errors, categorical agreement, clinical isolates
- MeSH terms
- Antifungal Agents, Candida, Humans, Laboratories, Microbial Sensitivity Tests, Predictive Value of Tests, Pyrimidines, Reference Standards, Triazoles, Fluconazole, Drug Resistance, Fungal, Voriconazole
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