Udskriv Udskriv
Switch language
Region Hovedstaden - en del af Københavns Universitetshospital

How to interpret MICs of antifungal compounds according to the revised clinical breakpoints v. 10.0 European committee on antimicrobial susceptibility testing (EUCAST)

Publikation: Bidrag til tidsskriftReviewpeer review


  1. 2020 List of human papillomavirus assays Suitable for primary cervical cancer screening

    Publikation: Bidrag til tidsskriftReviewpeer review

  2. Repeated introduction and spread of the MRSA clone t304/ST6 in Northern Europe

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  3. Invasive aspergillosis in patients with severe COVID-19 pneumonia

    Publikation: Bidrag til tidsskriftLetterpeer review

  4. Elevated plasma YKL-40 and risk of infectious disease: a prospective study of 94665 individuals from the general population

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  • Subcommittee on Antifungal Susceptibility Testing (AFST) of the ESCMID European Committee for Antimicrobial Susceptibility Testing (EUCAST)
Vis graf over relationer

BACKGROUND: EUCAST has revised the definition of the susceptibility category I from 'Intermediate' to 'Susceptible, Increased exposure'. This implies that I can be used where the drug concentration at the site of infection is high, either because of dose escalation or through other means to ensure efficacy. Consequently, I is no longer used as a buffer zone to prevent technical factors from causing misclassifications and discrepancies in interpretations. Instead, an Area of Technical Uncertainty (ATU) has been introduced for MICs that cannot be categorized without additional information as a warning to the laboratory that decision on how to act has to be made. To implement these changes, the EUCAST-AFST (Subcommittee on Antifungal Susceptibility Testing) reviewed all, and revised some, clinical antifungal breakpoints.

OBJECTIVES: The aim was to present an overview of the current antifungal breakpoints and supporting evidence behind the changes.

SOURCES: This document is based on the ten recently updated EUCAST rationale documents, clinical breakpoint and breakpoint ECOFF documents.

CONTENT: The following breakpoints (in mg/L) have been revised or established for Candida species: micafungin against C. albicans (ATU = 0.03); amphotericin B (S ≤/> R = 1/1), fluconazole (S ≤/> R = 2/4), itraconazole (S ≤/> R = 0.06/0.06), posaconazole (S ≤/> R = 0.06/0.06) and voriconazole (S ≤/> R = 0.06/0.25) against C. dubliniensis; fluconazole against C. glabrata (S ≤/> R = 0.001/16); and anidulafungin (S ≤/> R = 4/4) and micafungin (S ≤/> R = 2/2) against C. parapsilosis. For Aspergillus, new or revised breakpoints include itraconazole (ATU = 2) and isavuconazole against A. flavus (S ≤/> R = 1/2, ATU = 2); amphotericin B (S ≤/> R = 1/1), isavuconazole (S ≤ /> R = 1/2, ATU = 2), itraconazole (S ≤/> R = 1/1, ATU = 2), posaconazole (ATU = 0.25) and voriconazole (S ≤/> R = 1/1, ATU = 2) against A. fumigatus; itraconazole (S ≤/> R = 1/1, ATU = 2) and voriconazole (S ≤/> R = 1/1, ATU = 2) against A. nidulans; amphotericin B against A. niger (S ≤/> R = 1/1); and itraconazole (S ≤/> R = 1/1, ATU = 2) and posaconazole (ATU = 0.25) against A. terreus.

IMPLICATIONS: EUCAST-AFST has released ten new documents summarizing existing and new breakpoints and MIC ranges for control strains. A failure to adopt the breakpoint changes may lead to misclassifications and suboptimal or inappropriate therapy of patients with fungal infections.

TidsskriftClinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
Udgave nummer11
Sider (fra-til)1464-1472
Antal sider9
StatusUdgivet - nov. 2020

Bibliografisk note

Copyright © 2020. Published by Elsevier Ltd.

ID: 62329381