TABLE 4.
Rates of resistance to amphotericin B, fluconazole, voriconazole, and posaconazole for isolates of species with available breakpoints proposed by the CLSI M27-S3 document and the EUCAST procedurea
| Species (nb) | Category | % of isolates in category for antifungal agent |
|||||
|---|---|---|---|---|---|---|---|
| Fluconazole |
Voriconazole |
Posaconazole |
|||||
| CLSI | EUCAST | CLSI | EUCAST | CLSI | EUCAST | ||
| C. albicans (348) | SDD/I | 0 | 0.3 | 1.2 | 0 | NA | NA |
| R | 1.4 | 0.9 | 0.3 | 0.86 | 0.9 | 0.28 | |
| C. parapsilosis complex (200)c | SDD/I | 3 | 4 | 0.5 | NA | NA | NA |
| R | 2.5 | 0 | 0.5 | 0.5 | 1.5 | ||
| C. glabrata complex (103)d | SDD/I | 90.4 | 94.2 | NA | NA | NA | NA |
| R | 9.6 | 5.8 | 10.2 | NA | 2.9 | NA | |
| C. tropicalis (59) | SDD/I | 1.7 | 0 | 1.7 | 0 | NA | NA |
| R | 1.7 | 22 | 0 | 25.4 | 0 | 18.6 | |
| C. kruseie (15) | SDD/I | NA | NA | 0 | NA | NA | NA |
| R | 100 | 100 | 0 | NA | 6.7 | NA | |
| Overallf | SDD/I | 12.5 | 15.5 | 0.64 | NA | NA | NA |
| R/N-WT | 6 | 6.9 | 1.66 | 9.2 | 1.1 | 12.67 | |
The overall resistance rate also included non-wild-type isolates. NA, not applicable. SDD, susceptible, dose-dependent category, available only for fluconazole and voriconazole, as proposed in the CLSI M27-S4 document. I, intermediate category, available only for EUCAST and fluconazole (MIC = 4 mg/liter, except for C. glabrata, for which MIC > 0.002 to 32 mg/liter). N-WT, non-wild type.
n, no. of isolates.
Isolates of C. metapsilosis (n = 7) and C. orthopsilosis (n = 2) were considered to be C. parapsilosis for analysis of the rate of resistance.
The C. nivariensis isolate was considered to be C. glabrata for analysis of the rate of resistance.
Although EUCAST or CLSI do not provide fluconazole breakpoints for C. krusei, all the strains were considered resistant.
For CLSI, resistance rates were calculated including only the isolates from species with species-specific breakpoints; tentative resistance rates (non-wild-type isolates) were calculated by using the ECVs for the following species-drug combinations: fluconazole (C. lusitaniae, C. guilliiermondii, C. dubliniensis, and C. kefyr), voriconazole (C. glabrata, C. lusitaniae, C. guilliiermondii, C. dubliniensis, and C. kefyr), and posaconazole (C. albicans, C. parapsilosis, C. glabrata, C. tropicalis, C. krusei, C. lusitaniae, C. guilliermondii, C. dubliniensis, and C. kefyr); for the remaining Candida and non-Candida isolates, we tentatively used the C. albicans breakpoints. For EUCAST, tentative fluconazole breakpoints (S < 0.002; I = 0.004; R > 32, in mg/liter) were used for C. guilliermondii; isolates were considered tentatively resistant to voriconazole or posaconazole if showing an MIC > 0.12 mg/liter or > 0.06 mg/ml, respectively; for tentative breakpoints used for non-Candida yeasts, see Materials and Methods.