A 20-Year Antifungal Susceptibility Surveillance (From 1999 to 2019) for spp. and Proposed Epidemiological Cutoff Values for and : A Study in a Tertiary Hospital in China.

The emergence of resistant spp. is increasing worldwide. Long-term susceptibility surveillance for clinically isolated spp. strains is warranted for understanding the dynamic change in susceptibility and monitoring the emergence of resistance. Additionally, neither clinical breakpoints (CBPs) nor epidemiological cutoff values (ECVs) for spp. in China have been established. In this study, we performed a 20-year antifungal susceptibility surveillance for 706 isolates of spp. in a clinical laboratory at Peking University First Hospital from 1999 to 2019; and antifungal susceptibility to triazoles, caspofungin, and amphotericin B was determined by the Clinical and Laboratory Standards Institute (CLSI) broth microdilution method. It was observed that was the most common species, followed by and . Forty isolates (5.7%), including , , , , and , were classified as non-wild type (non-WT). Importantly, multidrug resistance was observed among , , and isolates. mutations were characterized for 19 non-WT isolates, and TR/L98H/S297T/F495I was the most prevalent mutation during the 20-year surveillance period. The overall resistance trend of increased over 20 years in China. Furthermore, based on ECV establishment principles, proposed ECVs for and were established using gathered minimum inhibitory concentration (MIC)/minimum effective concentration (MEC) data. Consequently, all the proposed ECVs were identical to the CLSI ECVs, with the exception of itraconazole against , resulting in a decrease in the non-WT rate from 6.0 to 0.6%.