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Clinical Usefulness of Susceptibility Breakpoints for Yeasts in the Treatment of Candidemia: A Noninterventional Study

This prospective noninterventional study evaluated whether antifungal susceptibility data (MIC) provided for Candida clinical isolates on the basis of recently established breakpoints are taken into account by clinicians to guide their treatment decision making process, and assessed the response in...

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Autores principales: Lass-Flörl, Cornelia, Krause, Robert, Willinger, Birgit, Starzengruber, Peter, Decristoforo, Petra, Neururer, Sabrina, Kreidl, Peter, Aigner, Maria
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7345773/
https://www.ncbi.nlm.nih.gov/pubmed/32498436
http://dx.doi.org/10.3390/jof6020076
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author Lass-Flörl, Cornelia
Krause, Robert
Willinger, Birgit
Starzengruber, Peter
Decristoforo, Petra
Neururer, Sabrina
Kreidl, Peter
Aigner, Maria
author_facet Lass-Flörl, Cornelia
Krause, Robert
Willinger, Birgit
Starzengruber, Peter
Decristoforo, Petra
Neururer, Sabrina
Kreidl, Peter
Aigner, Maria
author_sort Lass-Flörl, Cornelia
collection PubMed
description This prospective noninterventional study evaluated whether antifungal susceptibility data (MIC) provided for Candida clinical isolates on the basis of recently established breakpoints are taken into account by clinicians to guide their treatment decision making process, and assessed the response in MIC- and non-MIC-based treatment groups. During a six month period, the usage of systemic antifungals was recorded in detail and compared with mycological data (Candida species and MICs) in candidemia patients. Patients were assigned to a susceptible or resistant infection group based on European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints; treatment decisions were under the professional discretion of the treating physicians. 123 patients were evaluated with Candida albicans accounting for 59%, Candida glabrata for 19%, Candida parapsilosis for 15%, Candida tropicalis for 4% and Candida krusei for 3%. Antifungal treatment correlated with species and MICs in 80% (n = 99 patients), high MICs and species-dependent guideline recommendations were ignored in 20% (n = 24 patients); the overall outcome of candidemia cases in our study population was excellent, as by day 14, all patients were cleared from fungal blood stream infection (mean 5.6 days, range 2–12). The current variability in antifungal usage and the delay in initiating appropriate therapy indicate a need for antifungal stewardship to improve the management of invasive fungal infections.
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spelling pubmed-73457732020-07-09 Clinical Usefulness of Susceptibility Breakpoints for Yeasts in the Treatment of Candidemia: A Noninterventional Study Lass-Flörl, Cornelia Krause, Robert Willinger, Birgit Starzengruber, Peter Decristoforo, Petra Neururer, Sabrina Kreidl, Peter Aigner, Maria J Fungi (Basel) Article This prospective noninterventional study evaluated whether antifungal susceptibility data (MIC) provided for Candida clinical isolates on the basis of recently established breakpoints are taken into account by clinicians to guide their treatment decision making process, and assessed the response in MIC- and non-MIC-based treatment groups. During a six month period, the usage of systemic antifungals was recorded in detail and compared with mycological data (Candida species and MICs) in candidemia patients. Patients were assigned to a susceptible or resistant infection group based on European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints; treatment decisions were under the professional discretion of the treating physicians. 123 patients were evaluated with Candida albicans accounting for 59%, Candida glabrata for 19%, Candida parapsilosis for 15%, Candida tropicalis for 4% and Candida krusei for 3%. Antifungal treatment correlated with species and MICs in 80% (n = 99 patients), high MICs and species-dependent guideline recommendations were ignored in 20% (n = 24 patients); the overall outcome of candidemia cases in our study population was excellent, as by day 14, all patients were cleared from fungal blood stream infection (mean 5.6 days, range 2–12). The current variability in antifungal usage and the delay in initiating appropriate therapy indicate a need for antifungal stewardship to improve the management of invasive fungal infections. MDPI 2020-06-02 /pmc/articles/PMC7345773/ /pubmed/32498436 http://dx.doi.org/10.3390/jof6020076 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Lass-Flörl, Cornelia
Krause, Robert
Willinger, Birgit
Starzengruber, Peter
Decristoforo, Petra
Neururer, Sabrina
Kreidl, Peter
Aigner, Maria
Clinical Usefulness of Susceptibility Breakpoints for Yeasts in the Treatment of Candidemia: A Noninterventional Study
title Clinical Usefulness of Susceptibility Breakpoints for Yeasts in the Treatment of Candidemia: A Noninterventional Study
title_full Clinical Usefulness of Susceptibility Breakpoints for Yeasts in the Treatment of Candidemia: A Noninterventional Study
title_fullStr Clinical Usefulness of Susceptibility Breakpoints for Yeasts in the Treatment of Candidemia: A Noninterventional Study
title_full_unstemmed Clinical Usefulness of Susceptibility Breakpoints for Yeasts in the Treatment of Candidemia: A Noninterventional Study
title_short Clinical Usefulness of Susceptibility Breakpoints for Yeasts in the Treatment of Candidemia: A Noninterventional Study
title_sort clinical usefulness of susceptibility breakpoints for yeasts in the treatment of candidemia: a noninterventional study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7345773/
https://www.ncbi.nlm.nih.gov/pubmed/32498436
http://dx.doi.org/10.3390/jof6020076
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