Espinel-Ingroff Ana, Cantón Emilia
VCU Medical Center, Richmond, VA 23298, USA.
Severe Infection Research Group, Health Research Institute Hospital La Fe, 46026 Valencia, Spain.
J Fungi (Basel). 2023 May 5;9(5):542. doi: 10.3390/jof9050542.
When method-dependent categorical endpoints are available, namely either BPs or ECVs, MICs could aid in selecting the best treatment agent(s). BPs can categorize an isolate as either susceptible or resistant while the ECVs/ECOFFs can distinguish the wild type (WT, no known resistance mechanisms) from the Non-WT (NWT, harboring resistant mechanisms). Our literature review focused on the species complex (SC) and the available methods and categorization endpoints. We also covered the incidence of these infections as well as the numerous SC and SC genotypes. The most important agents to treat cryptococcal infections are fluconazole (widely used), amphotericin B, and flucytosine. We provide data from the collaborative study that defined CLSI fluconazole ECVs for the most common cryptococcal species or genotypes and modes. EUCAST ECVs/ECOFFs are not yet available for fluconazole. We have summarized the incidence of cryptococccal infections (2000-2015) where fluconazole MICs were obtained by reference and commercial antifungal susceptibility tests. This occurrence is documented all over the world and those fluconazole MICs are mostly categorized by available CLSI ECVs/BPs as "resistant" instead of non-susceptible strains, including those by the commercial methods. As expected, the agreement between the CLSI and commercial methods is variable because SYO and Etest data could yield low/variable agreement (<90%) versus the CLSI method. Therefore, since BPs/ECVs are species and method dependent, why not gather sufficient MICs by commercial methods and define the required ECVs for these species?
当有方法依赖的分类终点可用时，即BP或ECV，MIC有助于选择最佳治疗药物。BP可将分离株分类为敏感或耐药，而ECV/ECOFF可区分野生型（WT，无已知耐药机制）和非野生型（NWT，具有耐药机制）。我们的文献综述聚焦于菌种复合体（SC）以及可用的方法和分类终点。我们还涵盖了这些感染的发生率以及众多的SC和SC基因型。治疗隐球菌感染的最重要药物是氟康唑（广泛使用）、两性霉素B和氟胞嘧啶。我们提供了来自合作研究的数据，该研究定义了最常见隐球菌菌种或基因型及模式的CLSI氟康唑ECV。欧盟CAST尚未提供氟康唑的ECV/ECOFF。我们总结了通过参考和商业抗真菌药敏试验获得氟康唑MIC的隐球菌感染发生率（2000 - 2015年）。这种情况在世界各地都有记录，并且那些氟康唑MIC大多根据可用的CLSI ECV/BP分类为“耐药”，而不是非敏感菌株，包括通过商业方法检测的菌株。正如预期的那样，CLSI和商业方法之间的一致性是可变的，因为SYO和Etest数据与CLSI方法相比可能产生低/可变的一致性（<90%）。因此，由于BP/ECV依赖于菌种和方法，为什么不通过商业方法收集足够的MIC并为这些菌种定义所需的ECV呢？
