VCU Medical Center, Richmond, Virginia, USA.
Antimicrob Agents Chemother. 2012 Nov;56(11):5898-906. doi: 10.1128/AAC.01115-12. Epub 2012 Sep 4.
Epidemiological cutoff values (ECVs) for the Cryptococcus neoformans-Cryptococcus gattii species complex versus fluconazole, itraconazole, posaconazole, and voriconazole are not available. We established ECVs for these species and agents based on wild-type (WT) MIC distributions. A total of 2,985 to 5,733 CLSI MICs for C. neoformans (including isolates of molecular type VNI [MICs for 759 to 1,137 isolates] and VNII, VNIII, and VNIV [MICs for 24 to 57 isolates]) and 705 to 975 MICs for C. gattii (including 42 to 260 for VGI, VGII, VGIII, and VGIV isolates) were gathered in 15 to 24 laboratories (Europe, United States, Argentina, Australia, Brazil, Canada, Cuba, India, Mexico, and South Africa) and were aggregated for analysis. Additionally, 220 to 359 MICs measured using CLSI yeast nitrogen base (YNB) medium instead of CLSI RPMI medium for C. neoformans were evaluated. CLSI RPMI medium ECVs for distributions originating from at least three laboratories, which included ≥95% of the modeled WT population, were as follows: fluconazole, 8 μg/ml (VNI, C. gattii nontyped, VGI, VGIIa, and VGIII), 16 μg/ml (C. neoformans nontyped, VNIII, and VGIV), and 32 μg/ml (VGII); itraconazole, 0.25 μg/ml (VNI), 0.5 μg/ml (C. neoformans and C. gattii nontyped and VGI to VGIII), and 1 μg/ml (VGIV); posaconazole, 0.25 μg/ml (C. neoformans nontyped and VNI) and 0.5 μg/ml (C. gattii nontyped and VGI); and voriconazole, 0.12 μg/ml (VNIV), 0.25 μg/ml (C. neoformans and C. gattii nontyped, VNI, VNIII, VGII, and VGIIa,), and 0.5 μg/ml (VGI). The number of laboratories contributing data for other molecular types was too low to ascertain that the differences were due to factors other than assay variation. In the absence of clinical breakpoints, our ECVs may aid in the detection of isolates with acquired resistance mechanisms and should be listed in the revised CLSI M27-A3 and CLSI M27-S3 documents.
目前尚无新型隐球菌-格特隐球菌种复合体对抗真菌药物氟康唑、伊曲康唑、泊沙康唑和伏立康唑的流行病学截断值（ECV）。我们基于野生型（WT）MIC 分布，建立了这些种和药物的 ECV。共收集了来自 15 至 24 个实验室（欧洲、美国、阿根廷、澳大利亚、巴西、加拿大、古巴、印度、墨西哥和南非）的 2985 至 5733 株新型隐球菌（包括分子型 VNI[MIC 为 759 至 1137 株]和 VNII、VNIII、VNIV[MIC 为 24 至 57 株]）和 705 至 975 株格特隐球菌（包括 VGI、VGII、VGIII 和 VGIV 株的 MIC 为 42 至 260）的 CLSI MIC 值，并进行了汇总分析。此外，还评估了使用 CLSI 酵母氮基础（YNB）培养基而非 CLSI RPMI 培养基测量的 220 至 359 株新型隐球菌的 MIC 值。来自至少三个实验室的分布符合以下 CLSI RPMI 培养基 ECV：氟康唑 8μg/ml（VNI、无定型隐球菌、VGI、VGIIa 和 VGIII）、16μg/ml（无定型隐球菌、VNIII 和 VGIV）和 32μg/ml（VGII）；伊曲康唑 0.25μg/ml（VNI）、0.5μg/ml（新型隐球菌和无定型隐球菌以及 VGI 至 VGIII）和 1μg/ml（VGIV）；泊沙康唑 0.25μg/ml（无定型隐球菌和 VNI）和 0.5μg/ml（无定型隐球菌和 VGI）；伏立康唑 0.12μg/ml（VNIV）、0.25μg/ml（新型隐球菌和无定型隐球菌、VNI、VNIII、VGII 和 VGIIa）和 0.5μg/ml（VGI）。提供其他分子型数据的实验室数量太少，无法确定差异是否归因于检测变异性以外的因素。在没有临床断点的情况下，我们的 ECV 可能有助于检测获得性耐药机制的分离株，并应列入修订后的 CLSI M27-A3 和 CLSI M27-S3 文件中。
