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In vitro susceptibility testing to caspofungin and anidulafungin
of Candida spp. isolated from blood cultures in 7 Belgian
hospitals
C. Van Laer1*2,2 K. Lagrou2, P. Vandecandelaere3*, AM. Van den Abeele4*, J. Frans5*, R. Cartuyvels6*, E. Oris7*, H. De Beenhouwer1*, K. Van
Vaerenbergh1*, A. Boel1*
1
OLV Hospital, Aalst, 2 University Hospitals Leuven, Leuven, 3 Jan Yperman Hospital, Ieper, 4 Sint-Lucas Hospital, Ghent, 5 Imelda Hospital, Bonheiden,
Hasselt, 7 Hospital Zuid-Oost Limburg, Genk; Belgium. *On behalf of the BILULU study group.
Introduction
Candida spp. isolated from blood
cultures during a 9 month period in 7
Belgian hospitals were tested against 2
echinocandins,
anidulafungin
and
caspofungin.
Results were compared with previously
described susceptibility data (1).
Materials and methods
From December 2010 till August 2011,
all Candida spp. isolated from blood
cultures (n=104, no duplicates) were
collected in 7 Belgian hospitals:
• Onze Lieve Vrouw Hospital, Aalst (n=10)
• University Hospitals Leuven, Leuven
(n=55)
• Jan Yperman Hospital, Ieper (n=8)
• Sint-Lucas Hospital, Ghent (n=5)
• Imelda Hospital, Bonheiden (n=6)
• Jessa Hospital, Hasselt (n=10)
• Hospital Zuid-Oost Limburg, Genk (n=10)
All isolates were identified to species
level by ITS2 fragment length analysis.
Susceptibility testing was performed in
one centre on RPMI agar (AES
Chemunex Laboratoire, Bruz Cedex,
France) with E-test (Etest® BioMérieux,
Marcy-l’Etoile, France) for caspofungin
and anidulafungin .
Results were interpreted following CLSI
M27-S3 guidelines and ATCC 22019 C.
parapsilosis and ATCC 6258 C. krusei
were used as QC (2).
References
(1) Pfaller M. et al, Wild-Type MIC Distributions and
Epidemiological Cutoff Values for the Echinocandins
and Candida spp., JCM 2010, 48(1):52-56
(2) CLSI Reference Method for Broth Dilution Antifungal
Susceptibility Testing of Yeasts; 3th Informational
Supplement, M27-S3, vol 28 n°15
(3) M. Arendrup, Susceptibility testing of Fungi,
Antwerp 2011, Fungal infections and frustrations
across the border
Acknowledgement: The authors thank Pfizer for the
supply of materials for susceptibility testing: E-test and
RPMI agars.
contact: [email protected]
6
Jessa Hospital,
Results
Species distribution for the 104 Candida spp.
isolates was: 56 Candida albicans, 35 C.
glabrata, 8 C. parapsilosis, 2 C. tropicalis, 1 C.
krusei, 1 C. kefyr and 1 C. dubliniensis (fig 1).
Fig 1: Species distribution of 104 Candida spp. isolates
Overall MIC values (in µg/mL) for caspofungin ranged from 0,008 to 1,5 (MIC90:
0,25) and for anidulafungin from 0,002 to 4 (MIC90: 0,016), fig 2.
For C. albicans MIC values for caspofungin ranged from 0,008 to 0,32 (MIC90:
0,125) and for anidulafungin from 0,002 to 0,008 (MIC90: 0,004). MIC values for
all C. glabrata strains were in the same ranges as for C. albicans: 0,008-0,25
(MIC90: 0,19) for caspofungin and 0,002-0,016 (MIC90: 0,012) for anidulafungin
(fig 2). Other Candida strains (C. tropicalis, C. kefyr and C. dubliniensis) had low
MIC values for caspofungin and anidulafungin: 0,016-0,6 and 0,004-0,016
respectively.
The only Candida spp. with higher MIC values for the tested echinocandins was
C. parapsilosis with MIC values from 0,25 to 1,5 (MIC90: 1) for caspofungin and
from 1 to 4 (MIC90: 3) for anidulafungin, fig 2.
Fig 2: MIC distributions for anidulafungin and caspofungin for all Candida isolates, C. albicans , C. glabrata
and C. tropicalis
This study showed a difference in MIC values for
anidulafungin and caspofungin, with exception
of C. parapsilosis: MIC values were 3 to 4
dilution steps lower for anidulafungin than for
caspofungin. These findings were described by
M. Arendrup when susceptibility was
determined with E-test, instead of using CLSI
reference method, fig 3 (3).
C. albicans
Fig 3: MIC determined with E-test is different of ref.
method (3, with permission of Dr. M. Arendrup)
Conclusions
1. In accordance with previously published data, we obtained very low MIC
values for echinocandins for this Belgian C. albicans, C. glabrata, C. krusei
and C. kefyr isolates and higher MIC values for C. parapsilosis (1).
2. We remark that MIC values were 3 to 4 dilutions lower for anidulafungin
than for caspofungin. This observation was earlier described by M. Arendrup
when susceptibility testing was performed with E-test, fig 3 (3).