Evaluation of direct antifungal susceptibility testing using E-test for four antifungal agents in candidemia patients.

IF 2.3 3区 医学 Q3 INFECTIOUS DISEASES
Grégoire Miaux, Ryane Benkhelil, Gisèle Dewulf, Séverine Loridant, Eric Dannaoui, Edith Mazars
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引用次数: 0

Abstract

Candidemia is associated with high morbidity and mortality. Delayed initiation of effective and appropriate antifungal therapy correlates with increased patient mortality, emphasizing the importance of rapid antifungal susceptibility testing (AFST). Usual commercial methods, such as the standard E-test, are time-consuming, often requiring a minimum of 48 h. This study aimed to evaluate the performance of direct E-test (ET-dir) directly from positive blood culture bottles, with the goal of reducing turnaround time and improving clinical decision-making. A total of 160 yeast positive blood cultures were included over a 4-year period, comprising 85 Candida albicans. The minimum inhibitory concentrations (MICs) of fluconazole, voriconazole, amphotericin B, and anidulafungin were determined using ET-dir and compared to ET method (ET-sd). Essential agreement, categorical agreement, error rates, and bias were analyzed for all species and specifically for C. albicans. The essential agreement between ET-dir and ET-sd exceeded 87% for all antifungal agents and reached ≥90% for fluconazole. The categorical agreement was above 90% for all agents, and error rates remained within acceptable limits except for anidulafungin. For C. albicans, 23 of 24 performance data met acceptability criteria, with essential agreement ≥90% for all agents except fluconazole. ET-dir results were interpretable within 24 h for 93.7% of strains, providing at least a 24-h time gain over ET-sd. ET-dir is a reliable and rapid AFST method for candidemia, meeting most performance criteria compared to ET-sd while significantly reducing turnaround time. Its routine implementation could enable faster adaptation of antifungal therapy, ensuring that treatments are optimized based on susceptibility results.

念珠菌病患者4种抗真菌药物直接药敏试验的评价。
念珠菌病与高发病率和死亡率有关。延迟开始有效和适当的抗真菌治疗与患者死亡率增加相关,强调了快速抗真菌药敏试验(AFST)的重要性。通常的商业方法如标准E-test是耗时的,通常需要至少48小时。本研究旨在评估直接从阳性血培养瓶中进行的直接E-test (ET-dir)的性能,以减少周转时间和改善临床决策。在四年的时间里,总共有160个酵母阳性血液培养物,其中包括85个白色念珠菌。采用ET-dir法测定氟康唑、伏立康唑、两性霉素B和阿尼哌宁的最低抑菌浓度(mic),并与ET法(ET-sd)进行比较。分析了所有物种的基本一致性、分类一致性、错误率和偏倚,特别是白色念珠菌。所有抗真菌药物ET-dir和ET-sd的基本一致性超过87%,氟康唑达到≥90%。所有药物的绝对一致性都在90%以上,除anidulafungin外,错误率仍在可接受范围内。对于白色念珠菌,24项性能数据中有23项符合可接受标准,除氟康唑外,所有药物的基本一致性≥90%。93.7%的菌株在24小时内可解释ET-dir结果,比ET-sd至少有24小时的时间增益。ET-dir是一种可靠、快速的念珠菌AFST检测方法,与ET-sd相比,满足大多数性能标准,同时显著缩短周转时间。它的常规实施可以使抗真菌治疗更快地适应,确保根据敏感性结果优化治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Medical mycology
Medical mycology 医学-兽医学
CiteScore
5.70
自引率
3.40%
发文量
632
审稿时长
12 months
期刊介绍: Medical Mycology is a peer-reviewed international journal that focuses on original and innovative basic and applied studies, as well as learned reviews on all aspects of medical, veterinary and environmental mycology as related to disease. The objective is to present the highest quality scientific reports from throughout the world on divergent topics. These topics include the phylogeny of fungal pathogens, epidemiology and public health mycology themes, new approaches in the diagnosis and treatment of mycoses including clinical trials and guidelines, pharmacology and antifungal susceptibilities, changes in taxonomy, description of new or unusual fungi associated with human or animal disease, immunology of fungal infections, vaccinology for prevention of fungal infections, pathogenesis and virulence, and the molecular biology of pathogenic fungi in vitro and in vivo, including genomics, transcriptomics, metabolomics, and proteomics. Case reports are no longer accepted. In addition, studies of natural products showing inhibitory activity against pathogenic fungi are not accepted without chemical characterization and identification of the compounds responsible for the inhibitory activity.
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