Vahedi-Shahandashti Roya, Hahn Lisa, Houbraken Jos, Lass-Flörl Cornelia
Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, 6020 Innsbruck, Austria.
Westerdijk Fungal Biodiversity Institute, 3584 CT Utrecht, The Netherlands.
J Fungi (Basel). 2023 Feb 27;9(3):306. doi: 10.3390/jof9030306.
Providing timely antifungal treatment to patients suffering from life-threatening invasive fungal infections (IFIs) is essential. Due to the changing epidemiology and the emergence of antifungal resistance in , the most commonly responsible mold of IFIs, antifungal susceptibility testing (AFST) has become increasingly important to guide clinical decisions. This study assessed the essential agreement (EA) between broth microdilution methods (the Clinical and Laboratory Standards Institute (CLSI) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST)) and the Etest of amphotericin B (AmB), liposomal amphotericin B (L-AmB), and isavuconazole (ISA) against 112 section . An EA within ±2 dilutions of ≥90% between the two methods was considered acceptable. Excellent EA was found between EUCAST and CLSI of AmB and ISA (98.2% and 95.5%, respectively). The correlation of Etest results and EUCAST/CLSI was not acceptable (<90%) for any tested antifungal; however, Etest and CLSI for AmB (79.6%) and ISA (77.6%) showed a higher EA than Etest and EUCAST for AmB (49.5%) and ISA (46.4%). It was concluded that the Etest method requires its own clinical breakpoints (CBPs) and epidemiological cutoff values (ECVs), and interpreting Etest results using EUCAST and CLSI-adapted CBPs and ECVs could result in misinterpretation as Etest shows lower minimum inhibitory concentrations (MICs).
为患有危及生命的侵袭性真菌感染（IFI）的患者提供及时的抗真菌治疗至关重要。由于IFI最常见的致病霉菌的流行病学变化以及抗真菌耐药性的出现，抗真菌药敏试验（AFST）对于指导临床决策变得越来越重要。本研究评估了肉汤微量稀释法（临床和实验室标准协会（CLSI）和欧洲抗菌药物敏感性试验委员会（EUCAST））与两性霉素B（AmB）、脂质体两性霉素B（L-AmB）和艾沙康唑（ISA）的Etest法针对112株菌的基本一致性（EA）。两种方法之间在±2倍稀释内≥90%的EA被认为是可接受的。发现EUCAST和CLSI针对AmB和ISA的EA极佳（分别为98.2%和95.5%）。对于任何测试的抗真菌药物，Etest结果与EUCAST/CLSI的相关性均不可接受（<90%）；然而，AmB（79.6%）和ISA（77.6%）的Etest与CLSI显示出比AmB（49.5%）和ISA（46.4%）的Etest与EUCAST更高的EA。得出的结论是，Etest方法需要其自身的临床折点（CBP）和流行病学截断值（ECV），并且使用适应EUCAST和CLSI的CBP和ECV来解释Etest结果可能会导致错误解读，因为Etest显示出较低的最低抑菌浓度（MIC）。
