M Pfaller

..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...

..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...

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

..In the absence of CBPs for voriconazole and C. glabrata (and less common species), we recommend that their respective ECVs be used to detect the emergence of non-WT strains...

..This situation requires continuing attention. Rates of azole-resistant Aspergillus fumigatus are currently low, but there are reports of emerging resistance, including multi-azole resistant isolates in parts of Europe...

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..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...

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

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

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

..S, MIC <or= 8 microg/ml; susceptible-dose dependent (SDD), MIC = 16 to 32 microg/ml; R, MIC >or= 64 microg/ml. The corresponding disk test breakpoints are as follows: S, >or=19 mm; SDD, 15 to 18 mm; R, <or=14 mm...

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..5/1.0 microg/ml). C. guilliermondii, a species that exhibits reduced susceptibility to fluconazole, is the sixth most frequently isolated Candida species from this large survey and may be an emerging pathogen in Latin America...

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

..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...

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

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

..The College of American Pathologists Microbiology Surveys Program provides external proficiency samples that monitor the performance of nearly 3000 laboratories that perform and report antimicrobial susceptibility tests...

..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...

..06 microg/ml) and flucytosine (MIC(90), 0.12 microg/ml) and exhibited variable cross-resistance to posaconazole, ravuconazole, and voriconazole...

..Clinically, anidulafungin has been shown to be safe and effective in the treatment of oesophageal candidiasis and candidemia. Further clinical application of this new antifungal agent is warranted...

..0% with fluconazole. The YeastOne colorimetric method appears to be comparable to the NCCLS reference method for testing the susceptibility of Candida spp to the new triazoles voriconazole, posaconazole, and ravuconazole...

..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...

..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...

..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...

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

..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...

..All three test methods showed a high level of agreement and of ability to distinguish fks mutant strains of Candida species from WT strains using each of the echinocandins...

..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...

..fumigatus or A. flavus over time. Decreased susceptibility among Aspergillus spp. was observed for each of the extended-spectrum triazoles and varied by species over the 9-year study period...

..4% (posaconazole), and 99.6% (voriconazole) assessing EA at ±2 dilutions and 99.6% (itraconazole), 87.7% (posaconazole), and 96.3% (voriconazole) at ±1 dilution...

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

..to these important antifungal agents. The applications of ECVs to this large collection of Candida isolates suggests the potential to develop 24-h species-specific clinical breakpoints for both posaconazole and voriconazole...

..12 mcg/ml (I), and ? 0.25 mcg/ml (R). New, species-specific CBPs for Candida and the echinocandins are more sensitive to detect emerging resistance associated with fks mutations, and better able to predict risk for clinical failure...

..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...

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

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

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

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

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

..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...

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

..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...

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

..4%, with 0.1% VME. Both the MIC and the disk diffusion results obtained for fluconazole after only 24 h of incubation may be used to determine the susceptibilities of Candida spp. to this widely used antifungal agent...

..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...

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..Continued surveillance will be necessary to detect the emergence of these species as more prevalent, resistant pathogens. The new triazoles appear to offer acceptable coverage of uncommon Candida sp. bloodstream infections...

..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...

..catarrhalis in CARTI, and high fluoroquinolone potency/spectrum (>97% susceptible). beta-lactams and macrolides continue to be compromised by increasing resistances in pathogens isolated in these monitored primary care settings...

..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...

..The ability to characterize organisms phenotypically and genotypically is extremely powerful and provides unique information that is important in a global antimicrobial surveillance program...

..The Etest method using RPG agar appears to be a useful method for determining posaconazole susceptibilities of Candida species...

..Finally, procedures must be optimized for testing non-Candida yeasts (e.g., C. neoformans) and molds...

..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...

..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...

..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...

..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...

..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...

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..Etest results were somewhat easier to read on CAS. The Etest method using either RPG or CAS, but not MHA, appears to be a viable alternative to the NCCLS reference method for determining fluconazole susceptibilities of yeasts...

..Ongoing surveillance will enhance efforts to limit the extent of antifungal resistance in individuals in various age groups...

..These observations are generally encouraging relative to the sustained usefulness of fluconazole as a systemically active antifungal agent for the treatment of candida BSI...

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

..The anidulafungin MIC distribution showed that Candida albicans and C. glabrata were the most susceptible species and C. parapsilosis was the least susceptible species...

..The disk diffusion method using Mueller-Hinton agar supplemented with glucose and methylene blue appears to be a useful approach for determining the fluconazole susceptibility of C. neoformans...

..5 to 4 h) and concentration-independent activity (optimized at 4x MIC), suggest that 5FC could be used in lower doses to reduce host toxicity while maintaining antifungal efficacy...

..Micafungin has excellent in vitro activity against invasive clinical isolates of Candida from centers worldwide...

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..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...

..6% for voriconazole to 99.4% for amphotericin B. The TREK dried microdilution panel appears to be a viable alternative to frozen-broth microdilution panels for testing of Candida spp. and C. neoformans...

..Furthermore, results from this large, geographically diverse Candida spp. collection demonstrated that fks1 HS1 mutations remain uncommon among isolates with various echinocandin MIC levels...

..Natural deletion of ALS5 and the sequence variation within its coding region suggest relaxed selective pressure on this locus, and that Als5p function may be dispensable in C. albicans or redundant within the Als family...

..lusitaniae infection. The presence of colony variants on CAC may signal the emergence of amphotericin B resistance in C. lusitaniae and should be investigated...

..pneumoniae) was documented in all three monitored regions (Latin America > Europe > North America). Continued development of garenoxacin as a treatment of pathogens that commonly cause SSTIs appears to be warranted...

..All fluconazole-resistant isolates were inhibited by caspofungin at concentrations that can be exceeded by standard doses (MIC at which 90% of the isolates were inhibited, 1 micro g/ml; 99% of the MICs were </=2 micro g/ml)...

..03-1 mg/L). With a proposed breakpoint of < or =4 mg/L, BMS284756 may be a therapeutic alternative pending the results of clinical trials...

..5, and 1 microg/mL for staphylococci, enterococci, beta-hemolytic streptococci, and viridans group streptococci, respectively, and no significant loss in potency was observed over the period studied...

..Although uncommon, decreased S among Candida isolates was observed for each of the echinocandins and varied by species. Using ECVs is important in determining R trends among echinocandins and Candida...

..Both classic epidemiologic methods and molecular typing techniques were necessary to identify the source and extent of this outbreak...

..This review discusses the epidemiologic profiles of these invasive mycoses in North America, as well as risk factors for infection, and the pathogens' antifungal susceptibility...

..The lack of difference in mortality between species may reflect the overriding importance of host variables and/or a difference in virulence by species: further study is needed to investigate these hypotheses...

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..Fusidic acid was equally active against community-acquired MRSA and linezolid-resistant staphylococci. Fusidic acid exhibited equal or greater potency against staphylococci compared with vancomycin, daptomycin and linezolid...

..glabrata. Prompt species identification and fluconazole susceptibility testing are necessary to optimize therapy for invasive candidiasis...

..The establishment of the WT MEC distributions and ECVs for caspofungin and the major species of Aspergillus will be useful in resistance surveillance and is an important step toward the development of clinical breakpoints...

..Both species were very rare in this collection (0.2% prevalence), despite the number of isolates analyzed and the global distribution of the isolates. We saw no associated antifungal resistance in C. nivariensis...

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..Combinations of fluconazole and caspofungin or anidulafungin resulted in indifference. Azole-echinocandin combinations do not produce antagonistic effects; therefore, combinations of these agents may warrant future clinical evaluation...

..We suggest increased attention in Europe to: (1) the recognition of these resistant phenotypes, (2) infection control practices, and (3) limiting the overuse of certain selecting extended-spectrum beta-lactam agents (e.g. ceftazidime)...

..aureus nasal carriage. It remains to be seen whether preoperative weight loss would reduce the rate of nasal carriage. In addition, the value of screening this patient population for S. aureus nasal carriage merits further investigation...

..fumigatus. Overall, echinocandin and triazole resistance rates were minimal; however, the distinct increase in echinocandin resistance observed among C. glabrata strains warrants further surveillance associated with molecular support...

..1% ( Neisseria Haemophilus Identification Card; bioMérieux Vitek). Collectively, these results suggest that porphyrin-based testing methods represent the most reliable means for identifying Haemophilus spp...

..008/0.25 microg/mL; 98% susceptible). In comparison to 5866 Candida spp. isolates collected during global surveillance from 1997 to 2001, there were no changes in voriconazole mean MIC or MIC distribution...

..The most common resistant pathogen in US hospitals is ORSA, which accounts for many recognized outbreaks and is increasing in frequency in most facilities. Current practices to prevent and control antimicrobial resistance are inadequate...

..CONCLUSIONS: In Iowa, the epidemiology of MRSA differ from those of VRE. MRSA has become established in small rural hospitals. Effective MRSA control strategies may require inclusion of all hospitals in a state or region...