{"title":"Evaluation of direct antifungal susceptibility testing using E-test for four antifungal agents in candidemia patients.","authors":"Grégoire Miaux, Ryane Benkhelil, Gisèle Dewulf, Séverine Loridant, Eric Dannaoui, Edith Mazars","doi":"10.1093/mmy/myaf077","DOIUrl":null,"url":null,"abstract":"<p><p>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.</p>","PeriodicalId":18586,"journal":{"name":"Medical mycology","volume":" ","pages":""},"PeriodicalIF":2.3000,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Medical mycology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/mmy/myaf077","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
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.
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.