Abstract
Fungal diseases and antifungal resistance continue to increase, including those caused by rare or emerging species. However, the majority of the published in vitro susceptibility data are for the most common fungal species. We reviewed the literature in order to pool reference minimal inhibitory concentration (MIC) data (Clinical and Laboratory Standards Institute—CLSI and European Committee on Antimicrobial Susceptibility—EUCAST) for rare/non-prevalent Candida and other yeast species. MIC results were compared with those for Candida albicans, C. glabrata, and C. krusei. Data were listed for twenty rare and emerging Candida spp., including C. auris, as well as two Cryptococcus spp., two Trichosporon spp., Saccharomyces cerevisiae and five Malassezia spp. The best detectors of antimicrobial resistance are the breakpoints, which are not available for the less common Candida species. However, epidemiological cutoff values (ECVs/ECOFFs) have been calculated using merely in vitro data for both reference methods for various non-prevalent yeasts and recently the CLSI has established ECVs for other Candida species. The ECV could identify the non-wild type (NWT or mutants) isolates with known resistance mechanisms. Utilizing these ECVs, we were able to report additional percentages of NWT, especially for non-prevalent species, by analyzing the MIC distributions in the literature. In addition, since several antifungal drugs are under development, we are listing MIC data for some of these agents.
Highlights
Fungal infections are associated with high mortality and morbidity rates, especially among patients with invasive candidiasis and other systemic infections [1,2]
Mode: most frequent minimal inhibitory concentration (MIC) in the distribution; MIC90: value at which 90% of the isolates were inhibited. *MIC distribution having more than one mode. ** Geometric mean
The Clinical and Laboratory Standards Institute (CLSI) established echinocandin ECVs for five of the non-prevalent species listed in Tables 1 and 2: C. guilliermondii, C. lusitaniae, C. kefyr, C. metapsilosis, and C. orthopsilosis [9]
Summary
Fungal infections are associated with high mortality and morbidity rates, especially among patients with invasive candidiasis and other systemic infections [1,2]. M59 document including ECVs for some of the less prevalent Candida spp., C. neoformans and C. gattii, and that evaluations of various new antifungal agents under development have provided in vitro data for a variety of fungal species. These advances have allowed a more comprehensive evaluation of the antifungal susceptibility of less prevalent species including C. auris. (C. albicans, C. glabrata and C. krusei) and other yeasts versus both established and under development antifungal agents Olorofim was included in the search (formerly F901318), no data were available due to its little or no activity against Candida spp. or other yeasts
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