Service de parasitologie-mycologie, plateau technique de microbiologie, FMTS, université de Strasbourg, hôpitaux universitaires, Strasbourg, France.
Department of oncology and hematology, university hospital of Strasbourg, 67098 Strasbourg, France.
J Mycol Med. 2018 Mar;28(1):8-14. doi: 10.1016/j.mycmed.2018.02.005. Epub 2018 Mar 11.
Triazoles compounds are first-line agents for the treatment of invasive fungal diseases. Isavuconazole is the most recent triazole compound, approved in 2015 by the FDA and the EMA to treat invasive aspergillosis and mucormycosis. We reviewed here the in vitro activity of isavuconazole against a vast spectrum of species. Isavuconazole MICs were evaluated using CLSI, EUCAST or Etest methods, with no significant differences between the technics. Low MIC and MIC (<1μg/mL) were described for isavuconazole against the majority of Candida spp., except for C. glabrata and C. krusei. In vitro activity against Aspergillus spp. varied according to the species with an overall MIC of 1μg/mL ranging from 0.125μg/mL (A. fumigatus) to 16μg/mL (A. niger, A. tubingiensis). As for Aspergillus, the activity of isavuconazole against agents of mucormycosis varies upon genus and species, with an overall MIC from 4 (Rhizopus spp.) to 16μg/mL (Rhizomucor spp. and Mucor spp.). Recently, to help detecting non-wild-type isolates, EUCAST committee has proposed ECOFFs values for C. albicans, C. parapsilosis and C. tropicalis (0.03μg/mL), for Aspergillus fumigatus (2μg/mL), A. nidulans (0.25μg/mL), A. terreus (1μg/mL), A. flavus (2μg/mL) and A. niger (4μg/mL). Moreover, clinical breakpoints (susceptible/resistant) were defined for Aspergillus fumigatus (1μg/mL), A. nidulans (0.25μg/mL) and A. terreus (1μg/mL). Using these breakpoints, isavuconazole showed activity against the vast majority of fungi.
三唑类化合物是治疗侵袭性真菌感染的一线药物。伊曲康唑是最新的三唑类化合物，于 2015 年被 FDA 和 EMA 批准用于治疗侵袭性曲霉病和毛霉病。我们在这里回顾了伊曲康唑对广泛菌种的体外活性。使用 CLSI、EUCAST 或 Etest 方法评估伊曲康唑的 MIC，技术之间没有显著差异。大多数念珠菌属（除了光滑念珠菌和克柔念珠菌）对伊曲康唑的 MIC 较低（<1μg/mL）。伊曲康唑对曲霉菌属的体外活性因菌种而异，总体 MIC 为 1μg/mL，范围从 0.125μg/mL（烟曲霉）到 16μg/mL（黑曲霉、构巢曲霉）。与曲霉属一样，伊曲康唑对毛霉病病原体的活性因属和种而异，总体 MIC 从 4（根毛霉属）到 16μg/mL（犁头霉属和毛霉属）。最近，为了帮助检测非野生型分离株，EUCAST 委员会提出了 C. albicans、C. parapsilosis 和 C. tropicalis（0.03μg/mL）、A. fumigatus（2μg/mL）、A. nidulans（0.25μg/mL）、A. terreus（1μg/mL）、A. flavus（2μg/mL）和 A. niger（4μg/mL）的 ECOFFs 值。此外，还定义了 Aspergillus fumigatus（1μg/mL）、A. nidulans（0.25μg/mL）和 A. terreus（1μg/mL）的临床折点（敏感/耐药）。使用这些折点，伊曲康唑对绝大多数真菌均具有活性。
