M A Pfaller

..S. isolates. Isolates inhibited by >/=16 microg of fluconazole per ml were almost all (99%) inhibited by </=1 microg of voriconazole per ml. These results suggest that voriconazole may be useful in the treatment of cryptococcosis...

..9% of C. glabrata isolates (MIC90, 2.0 microg/ml) and 66.6% of C. krusei isolates were resistant to itraconazole. Within each species there were no geographic differences in susceptibility to fluconazole or itraconazole...

..Antimicrobial resistance continues to increase, and ongoing surveillance of microbial pathogens and resistance profiles is essential on national and international scales...

..The ASTY colorimetric microdilution panel method appears to be comparable to the NCCLS reference method for testing the susceptibilities of Candida spp. to a variety of antifungal agents...

..parapsilosis to fluconazole and voriconazole may vary by geographic region and clinical service...

..The dissemination of multidrug-resistant methicillin-resistant Staphylococcus aureus (MDR-MRSA) among the Latin American countries also was studied...

..aureus bloodstream isolates worldwide. Although many MDR-MRSA strains group geographically, a few closely related epidemic strains have wide regional and even global range...

..The results presented in this report confirm that bacterial resistance continues to be a great problem in Latin American medical institutions...

..coli and Klebsiella species from Latin America. Further investigation of the reasons for regional differences in resistance patterns is needed, as is ongoing surveillance to detect resistance trends and to guide antimicrobial use...

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..Ravuconazole is clearly an "extended-spectrum" triazole with potent in vitro activity against these rare and potentially "emerging" opportunistic pathogens...

..5 microg/ml. The new triazoles and caspofungin have excellent in vitro activity against a very large collection of recent clinical isolates of Aspergillus spp., and some in vitro activity against selected other filamentous fungi...

..that were dose-dependently fluconazole susceptible and against those that were fluconazole resistant...

..These organisms may pose a future threat to optimal antifungal therapy and emphasize the importance of prompt and accurate species identification...

..4 to 100% susceptible). Isolates from Canada and Latin America were generally more susceptible to both triazoles than U.S. isolates were. Continued surveillance appears necessary to detect these important changes...

..These results provide further evidence for the spectrum and potency of caspofungin activity against a large and geographically diverse collection of clinically important isolates of Candida spp...

..Ongoing surveillance remains essential, and will enhance efforts to limit the scope of this worldwide problem...

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..Clinical laboratories performing antifungal susceptibility testing of fluconazole against Candida spp. can reliably use these results as surrogate markers until commercial FDA-approved voriconazole susceptibility tests become available...

..albicans, 95.1%; C. glabrata, 94.3%; C. krusei, 91.6%; C. parapsilosis, 86.6%; and C. tropicalis, 86.4%. The Etest method using MH-GMB appears to be a useful method for determining amphotericin B susceptibilities of Candida species...

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..Candida tropicalis ATCC 750 was not useful for this purpose...

..and C. neoformans. These results provide further evidence for the increased spectrum and potency of the new triazoles against a large and geographically diverse collection of opportunistic fungal pathogens...

..25 microg/ml). C. krusei is an uncommon but multidrug-resistant fungal pathogen. Among the systemically active antifungal agents, the echinocandins appear to be the most active against this important pathogen...

..These results provide additional data in favor of the harmonization of these two methods...

..The agar-based methods performed well in identifying isolates with resistance to fluconazole and decreased susceptibility to voriconazole...

..These organisms may pose a future threat to optimal antifungal therapy and emphasize the importance of prompt and accurate species identification...

..to the echinocandins when using the new (lower) CBPs and ECVs. Further study using defined fks mutant strains of Candida is warranted...

..lusitaniae. With AM3, agreement ranged from 58% for C. glabrata to 100% for C. lusitaniae and C. guilliermondii. The Etest method using RPG appears to be a useful method for determining voriconazole susceptibilities of Candida species...

..These results suggest that BMS-207147, Sch 56592, and voriconazole all possess promising antifungal activity and that further in vitro and in vivo investigations are warranted to establish the clinical value of this improved potency...

..The establishment of the WT MIC distribution and ECVs for the azoles and A. fumigatus will be useful in resistance surveillance and is an important step toward the development of clinical breakpoints...

..These results provide further evidence for the spectrum and potency of anidulafungin activity against a large and geographically diverse collection of clinically important isolates of Candida spp...

..Fluconazole may serve as a surrogate marker to predict the susceptibility of Candida spp. to ravuconazole...

..The oldest age group (> or = 80 years) had the highest proportion of BSI isolates that were C. glabrata (32%) and the lowest rate of fluconazole resistance (5%)...

..The corresponding disk test breakpoints are as follows: S, > or = 17 mm; SDD, 14 to 16 mm; and R, < or = 13 mm...

..C. rugosa should be considered, along with the established pathogens Candida krusei and Candida glabrata, as a species of Candida with reduced susceptibility to the azole antifungal agents...

..Continued surveillance and refinement of broth- and agar-based test methods will help to identify susceptibility trends and improve the laboratory capability for antifungal susceptibility testing...

..Prepared MH-GMB agar plates provide acceptable performance for disk diffusion testing for at least 30 days when stored at 5 degrees C...

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..These organisms may pose a future threat to optimal antifungal therapy and underscore the importance of prompt and accurate species identification and antifungal susceptibility testing...

..9 to 97.4% at the 48-h BMD time point. The VITEK 2 system reliably detected flucytosine and voriconazole resistance among Candida spp. and demonstrated excellent quantitative and qualitative agreement with the reference BMD method...

..S. Bureau of the Census). Isolates from pediatric patients were virtually all susceptible to fluconazole, whereas the highest frequency of resistance was observed in isolates from patients 16 to 64 years of age...

..The Etest method using RPMI agar appears to be a useful method for determining fluconazole and voriconazole susceptibilities of uncommon species of Candida...

..Subsequently, the isolates should be submitted to a reference laboratory that will confirm the results by using a CLSI reference dilution method...

..fumigatus and A. flavus) were strongest between VOR and RAV MICs and ITR and POS MICs. However, Aspergillus species for which MICs of VOR or POS were >2 microg/ml remain extremely rare (<1% of isolates)...

..The MICs for >99% of isolates were </=1 microg/ml, and thus these isolates were differentiated from strains with reduced in vitro and in vivo susceptibilities to caspofungin...

..The CBP is inadequate in detecting the emergence of voriconazole resistance among most Candida species encountered clinically. The CBPs for voriconazole should be reassessed, with consideration for development of species-specific CBPs...

..In light of the new intravenous formulation of itraconazole these data suggest that this agent remains a viable systemically active antifungal agent...

..Micafungin may prove useful in the treatment of infections due to azole-resistant Candida...

..Our prospective sentinel surveillance reveals no evidence of emerging caspofungin resistance among invasive clinical isolates of Candida...

..0% M) when results for Candida krusei (not indicated for fluconazole testing) were omitted. Either fluconazole or voriconazole MIC results may serve as surrogate markers to predict the susceptibility of Candida spp. to posaconazole...

..9%) for C. guilliermondii. These WT MIC distributions and ECVs will be useful in surveillance for emerging reduced echinocandin susceptibility among Candida spp. and for determining the importance of various FKS1 or other mutations...

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..Both methods were sensitive and specific for detecting staphylococcal oxacillin resistance in the clinical microbiology laboratory...

..This novel desfluoro compound possesses promising activity against fastidious Gram-negative respiratory tract pathogens and further clinical development is underway...

..dubliniensis. A negative MDG test result with either system would also be helpful but may misclassify C. albicans as C. dubliniensis, especially when the API 20C AUX system is used...

..However, C. glabrata has emerged as an important and potentially antifungal resistant cause of candidemia, particularly among the elderly...

..krusei. These results provide further evidence for the spectrum and potency of ravuconazole and voriconazole against a large and geographically diverse collection of Candida spp...

..To investigate antimicrobial resistance in viridans group streptococci (VGS) among patients with and without the diagnosis of cancer in the USA, Canada and Latin America...

..Surveillance efforts should be expanded in order to monitor the spectrum of filamentous fungal pathogens and their in vitro susceptibility as these new antifungal agents are introduced into clinical use...

..The Etest method using RPMI agar appears to be a useful method for determining posaconazole susceptibilities of filamentous fungi...

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..Although the MRSA-Screen test required a slight procedural modification, both commercial methods achieved a sensitivity and specificity at detecting oxacillin resistance in CoNS at a level that was acceptable for clinical laboratory use...

..pneumoniae and Haemophilus influenzae (eight strains tested). CAT-mediated resistances dominate among chloramphenicol-resistant S. pneumoniae, and marked geographic variations in susceptibility were discovered...

..Modifications to the methods and alternative approaches have been proposed to make these tests more convenient and efficient, applicable to a greater number of species, and appropriate for performing in the clinical laboratory...

..Clinical laboratories can reliably use these suggested "surrogate markers" until reliable tests for gatifloxacin become available...

..The extended-spectrum fluoroquinolones appear well suited for community-acquired respiratory tract infection therapy, including pathogens other than pneumococcus, H influenzae, and M catarrhalis...

..It may be possible to test penicillin and use MICs obtained with penicillin to predict MICs of other beta-lactam antimicrobials for Streptococcus pneumoniae...

..marcescens and Enterobacter cloacae...

..The Etest method using RPG agar appears to be a useful method for determining the susceptibility of C. neoformans to voriconazole and amphotericin B...

..neoformans exists in a significant proportion of clinical isolates and that fluconazole resistance can be developed by selection from heteroresistant clones and induction by exposure to fluconazole...

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..The Etest method using RPMI agar appears to be a useful method for determining the voriconazole and itraconazole susceptibilities of Aspergillus spp...

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..These strains were selected from more than 24,000 isolates gathered as part of the 1999 SENTRY Antimicrobial Surveillance Program. Further clinical development appears warranted...

..This study provides important baseline data as the isolates were collected prior to fluconazole being made freely available to HIV/AIDS patients attending government health clinics...

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..Before antifungal time-kill curve methods are routinely employed by investigators, methodology should be scrutinized and standardized procedures should be developed...

..The VITEK 2 system reliably detected fluconazole resistance among Candida spp. and demonstrated excellent quantitative and qualitative agreement with the reference BMD method...

..e., time-kill curves and MFCs, we suggest that 80% reduction in visible growth be utilized as the endpoint for susceptibility determinations with LY303366 in RPMI medium...

..Further research to improve diagnostic, preventive, and therapeutic strategies is necessary to reduce the considerable morbidity and mortality associated with IC...

..EUCAST CBPs are species-specific, and apply only to C. albicans, C. tropicalis and C. parapsilosis, while CLSI CBPs apply to all species. We reassessed the CLSI CBPs for FLU and Candida in light of recent data...

..C. neoformans isolates were collected over a period of 7 years, during which time MICs at our institution remained stable...

..influenzae were observed only with cefaclor (12.8%) and TMP-SMX (16.2%)...

..g., Mucor and Fusarium). Further evaluation of fungal HDAC inhibitor-azole combinations is indicated...

..The increased potencies of the new triazole and echinocandin antifungal agents may provide effective therapeutic options for the treatment of infections due to C. dubliniensis...

..Continued in vitro, pharmacodynamic and clinical investigations of gemifloxacin appear warranted...

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..between animals and man...

..The YeastOne colorimetric method appears to be comparable to the CLSI reference method for testing the susceptibility of Candida spp. to the echinocandins anidulafungin, caspofungin, and micafungin...

..The overall agreement for each antifungal agent ranged from 96% for ravuconazole to 100% for amphotericin B. The Trek microdilution panel appears to be a viable alternative to frozen microdilution panels prepared in-house...

..12 microg/ml) are both active in vitro, and the new and investigational triazoles all have some in vitro activity, with ravuconazole being the most active (MIC(50), 0.25 microg/ml)...

..Proposed methods for fungal time-kill determinations and minimal fungicidal concentration determinations are also discussed...

..We conclude that in vitro resistance to antifungal agents used in the treatment of cryptococcosis remains uncommon among isolates of C. neoformans from five broad geographic regions and has not increased over a 15-year period...

..Molecular diagnosis is most appropriate for infectious agents that are difficult to detect, identify, or test for susceptibility in a timely fashion with conventional methods...

..This information should be helpful for clinicians as they consider empirical antimicrobial therapy for patients with suspected BSI across the age continuum...

..015 to 2.0 microg/ml) to determine if similar C(max)/MIC and AUC(0-24)/MIC ratios for these isolates were associated with efficacy. The anidulafungin exposures associated with efficacy were similar among Candida species...