American Society for Microbiology, Antimicrobial Agents and Chemotherapy, 4(58), p. 2006-2012, 2014
DOI: 10.1128/aac.02615-13
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ABSTRACT Although epidemiological cutoff values (ECVs) have been established for Candida spp. and the triazoles, they are based on MIC data from a single laboratory. We have established ECVs for eight Candida species and fluconazole, posaconazole, and voriconazole based on wild-type (WT) MIC distributions for isolates of C. albicans ( n = 11,241 isolates), C. glabrata (7,538), C. parapsilosis (6,023), C. tropicalis (3,748), C. krusei (1,073), C. lusitaniae (574), C. guilliermondii (373), and C. dubliniensis (162). The 24-h CLSI broth microdilution MICs were collated from multiple laboratories (in Canada, Brazil, Europe, Mexico, Peru, and the United States). The ECVs for distributions originating from ≥6 laboratories, which included ≥95% of the modeled WT population, for fluconazole, posaconazole, and voriconazole were, respectively, 0.5, 0.06 and 0.03 μg/ml for C. albicans , 0.5, 0.25, and 0.03 μg/ml for C. dubliniensis , 8, 1, and 0.25 μg/ml for C. glabrata , 8, 0.5, and 0.12 μg/ml for C. guilliermondii , 32, 0.5, and 0.25 μg/ml for C. krusei , 1, 0.06, and 0.06 μg/ml for C. lusitaniae , 1, 0.25, and 0.03 μg/ml for C. parapsilosis , and 1, 0.12, and 0.06 μg/ml for C. tropicalis . The low number of MICs (<100) for other less prevalent species ( C. famata , C. kefyr , C. orthopsilosis , C. rugosa ) precluded ECV definition, but their MIC distributions are documented. Evaluation of our ECVs for some species/agent combinations using published individual MICs for 136 isolates (harboring mutations in or upregulation of ERG11 , MDR1 , CDR1 , or CDR2 ) and 64 WT isolates indicated that our ECVs may be useful in distinguishing WT from non-WT isolates.