Wild-type MIC distributions and epidemiological cutoff values for the triazoles and six Aspergillus spp. for the CLSI broth microdilution method (M38-A2 document)

A Espinel-Ingroff; D J Diekema; A Fothergill; E Johnson; T Pelaez; M A Pfaller; M G Rinaldi; E Canton; J Turnidge

doi:10.1128/JCM.00536-10

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Wild-type MIC distributions and epidemiological cutoff values for the triazoles and six Aspergillus spp. for the CLSI broth microdilution method (M38-A2 document)

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Wild-type MIC distributions and epidemiological cutoff values for the triazoles and six Aspergillus spp. for the CLSI broth microdilution method (M38-A2 document)

A Espinel-Ingroff, D J Diekema, A Fothergill, E Johnson, T Pelaez, M A Pfaller, M G Rinaldi, E Canton and J Turnidge

Journal of clinical microbiology, Vol.48(9), pp.3251-3257

09/2010

DOI: 10.1128/JCM.00536-10

PMCID: PMC2937688

PMID: 20592159

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Abstract

Clinical breakpoints have not been established for mold testing. Wild-type (WT) MIC distributions (organisms in a species/drug combination with no detectable acquired resistance mechanisms) were defined in order to establish epidemiologic cutoff values (ECVs) for five Aspergillus spp. and itraconazole, posaconazole, and voriconazole. Also, we have expanded prior ECV data for Aspergillus fumigatus. The number of available isolates varied according to the species/triazole combination as follows: 1,684 to 2,815 for A. fumigatus, 323 to 592 for A. flavus, 131 to 143 for A. nidulans, 366 to 520 for A. niger, 330 to 462 for A. terreus, and 45 to 84 for A. versicolor. CLSI broth microdilution MIC data gathered in five independent laboratories in Europe and the United States were aggregated for the analyses. ECVs expressed in microg/ml were as follows (percentages of isolates for which MICs were equal to or less than the ECV are in parentheses): A. fumigatus, itraconazole, 1 (98.8%); posaconazole, 0.5 (99.2%); voriconazole, 1 (97.7%); A. flavus, itraconazole, 1 (99.6%); posaconazole, 0.25 (95%); voriconazole, 1 (98.1%); A. nidulans, itraconazole, 1 (95%); posaconazole, 1 (97.7%); voriconazole, 2 (99.3%); A. niger, itraconazole, 2 (100%); posaconazole, 0.5 (96.9%); voriconazole, 2 (99.4%); A. terreus, itraconazole, 1 (100%); posaconazole, 0.5 (99.7%); voriconazole, 1 (99.1%); A. versicolor, itraconazole, 2 (100%); posaconazole, 1 (not applicable); voriconazole, 2 (97.5%). Although ECVs do not predict therapy outcome as clinical breakpoints do, they may aid in detection of azole resistance (non-WT MIC) due to cyp51A mutations, a resistance mechanism in some Aspergillus spp. These ECVs should be considered for inclusion in the future CLSI M38-A2 document revision.

Antifungal Agents - pharmacology

Microbial Sensitivity Tests

Triazoles - pharmacology

United States

Europe

Humans

Aspergillosis - microbiology

Voriconazole

Aspergillus - isolation & purification

Pyrimidines - pharmacology

Itraconazole - pharmacology

Aspergillus - drug effects

Details

Title: Subtitle: Wild-type MIC distributions and epidemiological cutoff values for the triazoles and six Aspergillus spp. for the CLSI broth microdilution method (M38-A2 document)
Creators: A Espinel-Ingroff - VCU Medical Center, 3804 Dover Rd., Richmond, VA 23221, USA. avingrof@vcu.edu
D J Diekema
A Fothergill
E Johnson
T Pelaez
M A Pfaller
M G Rinaldi
E Canton
J Turnidge
Resource Type: Journal article
Publication Details: Journal of clinical microbiology, Vol.48(9), pp.3251-3257
Publisher: United States
DOI: 10.1128/JCM.00536-10
PMID: 20592159
PMCID: PMC2937688
ISSN: 1098-660X
eISSN: 1098-660X
Language: English
Date published: 09/2010
Academic Unit: Infectious Diseases; Epidemiology; Pathology; Internal Medicine
Record Identifier: 9983986365302771

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