Please use this identifier to cite or link to this item:
Scopus Web of Science® Altmetric
Type: Journal article
Title: Interlaboratory variability of caspofungin MICs for Candida spp. using CLSI and EUCAST methods: Should the clinical laboratory be testing this agent?
Author: Espinel-Ingroff, A.
Arendrup, M.
Pfaller, M.
Bonfietti, L.
Bustamante, B.
Canton, E.
Chryssanthou, E.
Cuenca-Estrella, M.
Dannaoui, E.
Fothergill, A.
Fuller, J.
Gaustad, P.
Gonzalez, G.
Guarro, J.
Lass-Florl, C.
Lockhart, S.
Meis, J.
Moore, C.
Ostrosky-Zeichner, L.
Pelaez, T.
et al.
Citation: Antimicrobial Agents and Chemotherapy, 2013; 57(12):5836-5842
Publisher: Amer Soc Microbiology
Issue Date: 2013
ISSN: 0066-4804
Statement of
A. Espinel-Ingroff ... J. Turnidge ... et al.
Abstract: Although Clinical and Laboratory Standards Institute (CLSI) clinical breakpoints (CBPs) are available for interpreting echinocandin MICs for Candida spp., epidemiologic cutoff values (ECVs) based on collective MIC data from multiple laboratories have not been defined. While collating CLSI caspofungin MICs for 145 to 11,550 Candida isolates from 17 laboratories (Brazil, Canada, Europe, Mexico, Peru, and the United States), we observed an extraordinary amount of modal variability (wide ranges) among laboratories as well as truncated and bimodal MIC distributions. The species-specific modes across different laboratories ranged from 0.016 to 0.5 μg/ml for C. albicans and C. tropicalis, 0.031 to 0.5 μg/ml for C. glabrata, and 0.063 to 1 μg/ml for C. krusei. Variability was also similar among MIC distributions for C. dubliniensis and C. lusitaniae. The exceptions were C. parapsilosis and C. guilliermondii MIC distributions, where most modes were within one 2-fold dilution of each other. These findings were consistent with available data from the European Committee on Antimicrobial Susceptibility Testing (EUCAST) (403 to 2,556 MICs) for C. albicans, C. glabrata, C. krusei, and C. tropicalis. Although many factors (caspofungin powder source, stock solution solvent, powder storage time length and temperature, and MIC determination testing parameters) were examined as a potential cause of such unprecedented variability, a single specific cause was not identified. Therefore, it seems highly likely that the use of the CLSI species-specific caspofungin CBPs could lead to reporting an excessive number of wild-type (WT) isolates (e.g., C. glabrata and C. krusei) as either non-WT or resistant isolates. Until this problem is resolved, routine testing or reporting of CLSI caspofungin MICs for Candida is not recommended; micafungin or anidulafungin data could be used instead.
Keywords: Humans
Antifungal Agents
Observer Variation
Microbial Sensitivity Tests
Drug Resistance, Fungal
Species Specificity
North America
South America
Rights: Copyright © 2013 White.
DOI: 10.1128/AAC.01519-13
Published version:
Appears in Collections:Aurora harvest 4
Molecular and Biomedical Science publications

Files in This Item:
There are no files associated with this item.

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.