Updated EUCAST Clinical Breakpoints against <i>Aspergillus</i>, Implications for the Clinical Microbiology Laboratory
Azole resistance poses a problem for the management of patients with invasive aspergillosis. Former species are in fact groups of closely related species (or complexes); cryptic species frequently show high antifungal resistance. The European Committee on Antimicrobial Susceptibility Testing (EUCAST...
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| Format: | Article |
| Language: | English |
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MDPI AG
2020-12-01
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| Series: | Journal of Fungi |
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| Online Access: | https://www.mdpi.com/2309-608X/6/4/343 |
| _version_ | 1797545550997880832 |
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| author | Jesús Guinea |
| author_facet | Jesús Guinea |
| author_sort | Jesús Guinea |
| collection | DOAJ |
| description | Azole resistance poses a problem for the management of patients with invasive aspergillosis. Former species are in fact groups of closely related species (or complexes); cryptic species frequently show high antifungal resistance. The European Committee on Antimicrobial Susceptibility Testing (EUCAST) Definitive Document (E.Def) 9.3.2 includes guidelines for antifungal susceptibility testing on <i>Aspergillus</i> spp. and clinical breakpoints for amphotericin B, itraconazole, voriconazole, posaconazole, and isavuconazole against <i>A. flavus</i>, <i>A. fumigatus</i>, <i>A. nidulans</i>, <i>A. niger</i>, and <i>A. terreus</i>. New clinical breakpoints were released in February 2020 and one of the most relevant modifications was the definition of the new “susceptible, increased exposure” (formerly “intermediate”) category. Another relevant change was the adoption of the concept of area of technical uncertainty (ATU) that refers to problematic areas which involve uncertainty of susceptibility categorisation (e.g., when minimum inhibitory concentrations (MICs) for susceptible and resistant organisms overlap). To accommodate both the new “susceptible, increased exposure” category and the concept of ATU, MICs of azoles and amphotericin B that fall in the former “intermediate” category have been automatically categorized as either R (amphotericin B) or ATU (triazoles). Finally, EUCAST-AFST (Antifungal Susceptibility Testing) decided to adopt new breakpoints for less common species provided that the epidemiological cut-off value (ECOFF) is below or comparable to the breakpoint for the type species (<i>A. fumigatus</i>). |
| first_indexed | 2024-03-10T14:17:58Z |
| format | Article |
| id | doaj.art-e9ca91091a0e4ad3a196a5ba761b6f9e |
| institution | Directory Open Access Journal |
| issn | 2309-608X |
| language | English |
| last_indexed | 2024-03-10T14:17:58Z |
| publishDate | 2020-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Fungi |
| spelling | doaj.art-e9ca91091a0e4ad3a196a5ba761b6f9e2023-11-20T23:41:56ZengMDPI AGJournal of Fungi2309-608X2020-12-016434310.3390/jof6040343Updated EUCAST Clinical Breakpoints against <i>Aspergillus</i>, Implications for the Clinical Microbiology LaboratoryJesús Guinea0Instituto de Investigación Sanitaria Gregorio Marañón, C/ Dr. Esquerdo, 46, 28007 Madrid, SpainAzole resistance poses a problem for the management of patients with invasive aspergillosis. Former species are in fact groups of closely related species (or complexes); cryptic species frequently show high antifungal resistance. The European Committee on Antimicrobial Susceptibility Testing (EUCAST) Definitive Document (E.Def) 9.3.2 includes guidelines for antifungal susceptibility testing on <i>Aspergillus</i> spp. and clinical breakpoints for amphotericin B, itraconazole, voriconazole, posaconazole, and isavuconazole against <i>A. flavus</i>, <i>A. fumigatus</i>, <i>A. nidulans</i>, <i>A. niger</i>, and <i>A. terreus</i>. New clinical breakpoints were released in February 2020 and one of the most relevant modifications was the definition of the new “susceptible, increased exposure” (formerly “intermediate”) category. Another relevant change was the adoption of the concept of area of technical uncertainty (ATU) that refers to problematic areas which involve uncertainty of susceptibility categorisation (e.g., when minimum inhibitory concentrations (MICs) for susceptible and resistant organisms overlap). To accommodate both the new “susceptible, increased exposure” category and the concept of ATU, MICs of azoles and amphotericin B that fall in the former “intermediate” category have been automatically categorized as either R (amphotericin B) or ATU (triazoles). Finally, EUCAST-AFST (Antifungal Susceptibility Testing) decided to adopt new breakpoints for less common species provided that the epidemiological cut-off value (ECOFF) is below or comparable to the breakpoint for the type species (<i>A. fumigatus</i>).https://www.mdpi.com/2309-608X/6/4/343<i>Aspergillus</i>antifungal resistanceazolesamphotericin BEUCASTclinical breakpoints |
| spellingShingle | Jesús Guinea Updated EUCAST Clinical Breakpoints against <i>Aspergillus</i>, Implications for the Clinical Microbiology Laboratory Journal of Fungi <i>Aspergillus</i> antifungal resistance azoles amphotericin B EUCAST clinical breakpoints |
| title | Updated EUCAST Clinical Breakpoints against <i>Aspergillus</i>, Implications for the Clinical Microbiology Laboratory |
| title_full | Updated EUCAST Clinical Breakpoints against <i>Aspergillus</i>, Implications for the Clinical Microbiology Laboratory |
| title_fullStr | Updated EUCAST Clinical Breakpoints against <i>Aspergillus</i>, Implications for the Clinical Microbiology Laboratory |
| title_full_unstemmed | Updated EUCAST Clinical Breakpoints against <i>Aspergillus</i>, Implications for the Clinical Microbiology Laboratory |
| title_short | Updated EUCAST Clinical Breakpoints against <i>Aspergillus</i>, Implications for the Clinical Microbiology Laboratory |
| title_sort | updated eucast clinical breakpoints against i aspergillus i implications for the clinical microbiology laboratory |
| topic | <i>Aspergillus</i> antifungal resistance azoles amphotericin B EUCAST clinical breakpoints |
| url | https://www.mdpi.com/2309-608X/6/4/343 |
| work_keys_str_mv | AT jesusguinea updatedeucastclinicalbreakpointsagainstiaspergillusiimplicationsfortheclinicalmicrobiologylaboratory |