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Antifungal susceptibilities of bloodstream isolates of Candida species from nine hospitals in Korea: application of new antifungal breakpoints and relationship to antifungal usage.

Won EJ, Shin JH, Choi MJ, Lee WG, Park YJ, Uh Y, Kim SY, Lee MK, Kim SH, Shin MG, Suh SP, Ryang DW - PLoS ONE (2015)

Bottom Line: However, non-susceptibility to voriconazole, caspofungin, or micafungin was found in 0% (0/370), 0% (0/437), or 0.5% (2/437) of the Candida BSI isolates, respectively.By Spearman's correlation analysis, fluconazole usage did not show a significant correlation with the percentage of fluconazole resistant isolates at hospitals.However, fluconazole usage was significantly correlated with the percentage of fluconazole non-susceptible isolates (r = 0.733; P = 0.025) or the percentage of isolates with decreased susceptibility to fluconazole (MIC ≥4 μg/ml) (r = 0.700; P = 0.036) at hospitals.

View Article: PubMed Central - PubMed

Affiliation: Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.

ABSTRACT
We applied the new clinical breakpoints (CBPs) of the Clinical and Laboratory Standards Institute (CLSI) to a multicenter study to determine the antifungal susceptibility of bloodstream infection (BSI) isolates of Candida species in Korea, and determined the relationship between the frequency of antifungal-resistant Candida BSI isolates and antifungal use at hospitals. Four hundred and fifty BSI isolates of Candida species were collected over a 1-year period in 2011 from nine hospitals. The susceptibilities of the isolates to four antifungal agents were determined using the CLSI M27 broth microdilution method. By applying the species-specific CBPs, non-susceptibility to fluconazole was found in 16.4% (70/428) of isolates, comprising 2.6% resistant and 13.8% susceptible-dose dependent isolates. However, non-susceptibility to voriconazole, caspofungin, or micafungin was found in 0% (0/370), 0% (0/437), or 0.5% (2/437) of the Candida BSI isolates, respectively. Of the 450 isolates, 72 (16.0%) showed decreased susceptibility to fluconazole [minimum inhibitory concentration (MIC) ≥4 μg/ml]. The total usage of systemic antifungals varied considerably among the hospitals, ranging from 190.0 to 7.7 defined daily dose per 1,000 patient days, and fluconazole was the most commonly prescribed agent (46.3%). By Spearman's correlation analysis, fluconazole usage did not show a significant correlation with the percentage of fluconazole resistant isolates at hospitals. However, fluconazole usage was significantly correlated with the percentage of fluconazole non-susceptible isolates (r = 0.733; P = 0.025) or the percentage of isolates with decreased susceptibility to fluconazole (MIC ≥4 μg/ml) (r = 0.700; P = 0.036) at hospitals. Our work represents the first South Korean multicenter study demonstrating an association between antifungal use and antifungal resistance among BSI isolates of Candida at hospitals using the new CBPs of the CLSI.

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Relationship between the fluconazole usage and the percentage of isolates with non-susceptible to fluconazole, or isolates with decreased susceptibility to fluconazole (MIC ≥4 μg/ml) at nine university hospitals in Korea.The usage of fluconazole, defined as the daily dose/1,000 patient days (DDD/1,000 PD) at the individual hospital was represented by the grey columns. The percentage of isolates with non-susceptible to fluconazole (closed circle with solid line) and the percentage of isolates with decreased susceptibility to fluconazole (MIC ≥4 μg/ml) (open rectangle with dotted line) showed positive correlations with the usage of fluconazole at the individual hospitals.
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pone.0118770.g001: Relationship between the fluconazole usage and the percentage of isolates with non-susceptible to fluconazole, or isolates with decreased susceptibility to fluconazole (MIC ≥4 μg/ml) at nine university hospitals in Korea.The usage of fluconazole, defined as the daily dose/1,000 patient days (DDD/1,000 PD) at the individual hospital was represented by the grey columns. The percentage of isolates with non-susceptible to fluconazole (closed circle with solid line) and the percentage of isolates with decreased susceptibility to fluconazole (MIC ≥4 μg/ml) (open rectangle with dotted line) showed positive correlations with the usage of fluconazole at the individual hospitals.

Mentions: When the species-specific new CBPs were applied, the percentage of fluconazole non-susceptible Candida BSI isolates varied among the nine hospitals from 5.3% to 33.3% (Table 2). Because revised species-specific CBPs are not at present available for less common Candida species, we also assessed the percentage of decreased susceptibility to fluconazole (MIC ≥4 μg/ml) in all 450 BSI isolates, which also varied among the hospitals from 5.3% to 26.5%. By Spearman’s correlation analysis, total fluconazole usage showed positive correlations with the percentage of isolates with decreased susceptibility to fluconazole (MIC ≥4 μg/ml) (r = 0.700, P = 0.036) at hospitals (Fig. 1). Moreover, the incidence of candidemia caused by fluconazole non-susceptible Candida isolates showed positive correlations with usage of total fluconazole (r = 0.733, P = 0.025) or oral fluconazole (r = 0.8, P = 0.01).


Antifungal susceptibilities of bloodstream isolates of Candida species from nine hospitals in Korea: application of new antifungal breakpoints and relationship to antifungal usage.

Won EJ, Shin JH, Choi MJ, Lee WG, Park YJ, Uh Y, Kim SY, Lee MK, Kim SH, Shin MG, Suh SP, Ryang DW - PLoS ONE (2015)

Relationship between the fluconazole usage and the percentage of isolates with non-susceptible to fluconazole, or isolates with decreased susceptibility to fluconazole (MIC ≥4 μg/ml) at nine university hospitals in Korea.The usage of fluconazole, defined as the daily dose/1,000 patient days (DDD/1,000 PD) at the individual hospital was represented by the grey columns. The percentage of isolates with non-susceptible to fluconazole (closed circle with solid line) and the percentage of isolates with decreased susceptibility to fluconazole (MIC ≥4 μg/ml) (open rectangle with dotted line) showed positive correlations with the usage of fluconazole at the individual hospitals.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4338005&req=5

pone.0118770.g001: Relationship between the fluconazole usage and the percentage of isolates with non-susceptible to fluconazole, or isolates with decreased susceptibility to fluconazole (MIC ≥4 μg/ml) at nine university hospitals in Korea.The usage of fluconazole, defined as the daily dose/1,000 patient days (DDD/1,000 PD) at the individual hospital was represented by the grey columns. The percentage of isolates with non-susceptible to fluconazole (closed circle with solid line) and the percentage of isolates with decreased susceptibility to fluconazole (MIC ≥4 μg/ml) (open rectangle with dotted line) showed positive correlations with the usage of fluconazole at the individual hospitals.
Mentions: When the species-specific new CBPs were applied, the percentage of fluconazole non-susceptible Candida BSI isolates varied among the nine hospitals from 5.3% to 33.3% (Table 2). Because revised species-specific CBPs are not at present available for less common Candida species, we also assessed the percentage of decreased susceptibility to fluconazole (MIC ≥4 μg/ml) in all 450 BSI isolates, which also varied among the hospitals from 5.3% to 26.5%. By Spearman’s correlation analysis, total fluconazole usage showed positive correlations with the percentage of isolates with decreased susceptibility to fluconazole (MIC ≥4 μg/ml) (r = 0.700, P = 0.036) at hospitals (Fig. 1). Moreover, the incidence of candidemia caused by fluconazole non-susceptible Candida isolates showed positive correlations with usage of total fluconazole (r = 0.733, P = 0.025) or oral fluconazole (r = 0.8, P = 0.01).

Bottom Line: However, non-susceptibility to voriconazole, caspofungin, or micafungin was found in 0% (0/370), 0% (0/437), or 0.5% (2/437) of the Candida BSI isolates, respectively.By Spearman's correlation analysis, fluconazole usage did not show a significant correlation with the percentage of fluconazole resistant isolates at hospitals.However, fluconazole usage was significantly correlated with the percentage of fluconazole non-susceptible isolates (r = 0.733; P = 0.025) or the percentage of isolates with decreased susceptibility to fluconazole (MIC ≥4 μg/ml) (r = 0.700; P = 0.036) at hospitals.

View Article: PubMed Central - PubMed

Affiliation: Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.

ABSTRACT
We applied the new clinical breakpoints (CBPs) of the Clinical and Laboratory Standards Institute (CLSI) to a multicenter study to determine the antifungal susceptibility of bloodstream infection (BSI) isolates of Candida species in Korea, and determined the relationship between the frequency of antifungal-resistant Candida BSI isolates and antifungal use at hospitals. Four hundred and fifty BSI isolates of Candida species were collected over a 1-year period in 2011 from nine hospitals. The susceptibilities of the isolates to four antifungal agents were determined using the CLSI M27 broth microdilution method. By applying the species-specific CBPs, non-susceptibility to fluconazole was found in 16.4% (70/428) of isolates, comprising 2.6% resistant and 13.8% susceptible-dose dependent isolates. However, non-susceptibility to voriconazole, caspofungin, or micafungin was found in 0% (0/370), 0% (0/437), or 0.5% (2/437) of the Candida BSI isolates, respectively. Of the 450 isolates, 72 (16.0%) showed decreased susceptibility to fluconazole [minimum inhibitory concentration (MIC) ≥4 μg/ml]. The total usage of systemic antifungals varied considerably among the hospitals, ranging from 190.0 to 7.7 defined daily dose per 1,000 patient days, and fluconazole was the most commonly prescribed agent (46.3%). By Spearman's correlation analysis, fluconazole usage did not show a significant correlation with the percentage of fluconazole resistant isolates at hospitals. However, fluconazole usage was significantly correlated with the percentage of fluconazole non-susceptible isolates (r = 0.733; P = 0.025) or the percentage of isolates with decreased susceptibility to fluconazole (MIC ≥4 μg/ml) (r = 0.700; P = 0.036) at hospitals. Our work represents the first South Korean multicenter study demonstrating an association between antifungal use and antifungal resistance among BSI isolates of Candida at hospitals using the new CBPs of the CLSI.

Show MeSH
Related in: MedlinePlus