Antifungal susceptibilities of bloodstream isolates of Candida species from nine hospitals in Korea: application of new antifungal breakpoints and relationship to antifungal usage
We applied the new clinical breakpoints (CBPs) of the Clinical and Laboratory Standards Institute (CLSI) to a multicenter study to determine the antifungal susceptibility of bloodstream infection (BSI) isolates of Candida species in Korea, and determined the relationship between the frequency of ant...
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| Veröffentlicht in: | PloS one 2015-02, Vol.10 (2), p.e0118770-e0118770 |
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| creator | Won, Eun Jeong Shin, Jong Hee Choi, Min Ji Lee, Wee Gyo Park, Yeon-Joon Uh, Young Kim, Shine-Young Lee, Mi-Kyung Kim, Soo Hyun Shin, Myung Geun Suh, Soon Pal Ryang, Dong Wook |
| description | We applied the new clinical breakpoints (CBPs) of the Clinical and Laboratory Standards Institute (CLSI) to a multicenter study to determine the antifungal susceptibility of bloodstream infection (BSI) isolates of Candida species in Korea, and determined the relationship between the frequency of antifungal-resistant Candida BSI isolates and antifungal use at hospitals. Four hundred and fifty BSI isolates of Candida species were collected over a 1-year period in 2011 from nine hospitals. The susceptibilities of the isolates to four antifungal agents were determined using the CLSI M27 broth microdilution method. By applying the species-specific CBPs, non-susceptibility to fluconazole was found in 16.4% (70/428) of isolates, comprising 2.6% resistant and 13.8% susceptible-dose dependent isolates. However, non-susceptibility to voriconazole, caspofungin, or micafungin was found in 0% (0/370), 0% (0/437), or 0.5% (2/437) of the Candida BSI isolates, respectively. Of the 450 isolates, 72 (16.0%) showed decreased susceptibility to fluconazole [minimum inhibitory concentration (MIC) ≥4 μg/ml]. The total usage of systemic antifungals varied considerably among the hospitals, ranging from 190.0 to 7.7 defined daily dose per 1,000 patient days, and fluconazole was the most commonly prescribed agent (46.3%). By Spearman's correlation analysis, fluconazole usage did not show a significant correlation with the percentage of fluconazole resistant isolates at hospitals. However, fluconazole usage was significantly correlated with the percentage of fluconazole non-susceptible isolates (r = 0.733; P = 0.025) or the percentage of isolates with decreased susceptibility to fluconazole (MIC ≥4 μg/ml) (r = 0.700; P = 0.036) at hospitals. Our work represents the first South Korean multicenter study demonstrating an association between antifungal use and antifungal resistance among BSI isolates of Candida at hospitals using the new CBPs of the CLSI. |
| doi_str_mv | 10.1371/journal.pone.0118770 |
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Four hundred and fifty BSI isolates of Candida species were collected over a 1-year period in 2011 from nine hospitals. The susceptibilities of the isolates to four antifungal agents were determined using the CLSI M27 broth microdilution method. By applying the species-specific CBPs, non-susceptibility to fluconazole was found in 16.4% (70/428) of isolates, comprising 2.6% resistant and 13.8% susceptible-dose dependent isolates. However, non-susceptibility to voriconazole, caspofungin, or micafungin was found in 0% (0/370), 0% (0/437), or 0.5% (2/437) of the Candida BSI isolates, respectively. Of the 450 isolates, 72 (16.0%) showed decreased susceptibility to fluconazole [minimum inhibitory concentration (MIC) ≥4 μg/ml]. The total usage of systemic antifungals varied considerably among the hospitals, ranging from 190.0 to 7.7 defined daily dose per 1,000 patient days, and fluconazole was the most commonly prescribed agent (46.3%). By Spearman's correlation analysis, fluconazole usage did not show a significant correlation with the percentage of fluconazole resistant isolates at hospitals. However, fluconazole usage was significantly correlated with the percentage of fluconazole non-susceptible isolates (r = 0.733; P = 0.025) or the percentage of isolates with decreased susceptibility to fluconazole (MIC ≥4 μg/ml) (r = 0.700; P = 0.036) at hospitals. Our work represents the first South Korean multicenter study demonstrating an association between antifungal use and antifungal resistance among BSI isolates of Candida at hospitals using the new CBPs of the CLSI.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0118770</identifier><identifier>PMID: 25706866</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Antifungal agents ; Antifungal Agents - pharmacology ; Breakpoints ; Candida ; Candida - drug effects ; Candida albicans ; Candida krusei ; Candida parapsilosis ; Caspofungin ; Correlation ; Correlation analysis ; Dosage ; Drug use ; Epidemiology ; Fluconazole ; Fungemia - microbiology ; Fungicides ; Hospitals ; Humans ; Identification ; Laboratories ; Medical schools ; Medicine ; Methods ; Micafungin ; Microbial Sensitivity Tests ; Minimum inhibitory concentration ; Patients ; Republic of Korea ; Species ; Studies ; Surveillance ; Voriconazole</subject><ispartof>PloS one, 2015-02, Vol.10 (2), p.e0118770-e0118770</ispartof><rights>2015 Won et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2015 Won et al 2015 Won et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c526t-2c60d384ae192c39978109863bd3fe5c9575b90ef3c00114211988c92ae6d49f3</citedby><cites>FETCH-LOGICAL-c526t-2c60d384ae192c39978109863bd3fe5c9575b90ef3c00114211988c92ae6d49f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4338005/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4338005/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79343,79344</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25706866$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Won, Eun Jeong</creatorcontrib><creatorcontrib>Shin, Jong Hee</creatorcontrib><creatorcontrib>Choi, Min Ji</creatorcontrib><creatorcontrib>Lee, Wee Gyo</creatorcontrib><creatorcontrib>Park, Yeon-Joon</creatorcontrib><creatorcontrib>Uh, Young</creatorcontrib><creatorcontrib>Kim, Shine-Young</creatorcontrib><creatorcontrib>Lee, Mi-Kyung</creatorcontrib><creatorcontrib>Kim, Soo Hyun</creatorcontrib><creatorcontrib>Shin, Myung Geun</creatorcontrib><creatorcontrib>Suh, Soon Pal</creatorcontrib><creatorcontrib>Ryang, Dong Wook</creatorcontrib><title>Antifungal susceptibilities of bloodstream isolates of Candida species from nine hospitals in Korea: application of new antifungal breakpoints and relationship to antifungal usage</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>We applied the new clinical breakpoints (CBPs) of the Clinical and Laboratory Standards Institute (CLSI) to a multicenter study to determine the antifungal susceptibility of bloodstream infection (BSI) isolates of Candida species in Korea, and determined the relationship between the frequency of antifungal-resistant Candida BSI isolates and antifungal use at hospitals. Four hundred and fifty BSI isolates of Candida species were collected over a 1-year period in 2011 from nine hospitals. The susceptibilities of the isolates to four antifungal agents were determined using the CLSI M27 broth microdilution method. By applying the species-specific CBPs, non-susceptibility to fluconazole was found in 16.4% (70/428) of isolates, comprising 2.6% resistant and 13.8% susceptible-dose dependent isolates. However, non-susceptibility to voriconazole, caspofungin, or micafungin was found in 0% (0/370), 0% (0/437), or 0.5% (2/437) of the Candida BSI isolates, respectively. Of the 450 isolates, 72 (16.0%) showed decreased susceptibility to fluconazole [minimum inhibitory concentration (MIC) ≥4 μg/ml]. The total usage of systemic antifungals varied considerably among the hospitals, ranging from 190.0 to 7.7 defined daily dose per 1,000 patient days, and fluconazole was the most commonly prescribed agent (46.3%). By Spearman's correlation analysis, fluconazole usage did not show a significant correlation with the percentage of fluconazole resistant isolates at hospitals. However, fluconazole usage was significantly correlated with the percentage of fluconazole non-susceptible isolates (r = 0.733; P = 0.025) or the percentage of isolates with decreased susceptibility to fluconazole (MIC ≥4 μg/ml) (r = 0.700; P = 0.036) at hospitals. Our work represents the first South Korean multicenter study demonstrating an association between antifungal use and antifungal resistance among BSI isolates of Candida at hospitals using the new CBPs of the CLSI.</description><subject>Antifungal agents</subject><subject>Antifungal Agents - pharmacology</subject><subject>Breakpoints</subject><subject>Candida</subject><subject>Candida - drug effects</subject><subject>Candida albicans</subject><subject>Candida krusei</subject><subject>Candida parapsilosis</subject><subject>Caspofungin</subject><subject>Correlation</subject><subject>Correlation analysis</subject><subject>Dosage</subject><subject>Drug use</subject><subject>Epidemiology</subject><subject>Fluconazole</subject><subject>Fungemia - microbiology</subject><subject>Fungicides</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Identification</subject><subject>Laboratories</subject><subject>Medical schools</subject><subject>Medicine</subject><subject>Methods</subject><subject>Micafungin</subject><subject>Microbial Sensitivity Tests</subject><subject>Minimum inhibitory concentration</subject><subject>Patients</subject><subject>Republic of Korea</subject><subject>Species</subject><subject>Studies</subject><subject>Surveillance</subject><subject>Voriconazole</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNptUsuO0zAUjRCIGQp_gMASGzYtdhw7MYuRRhWPESOxgbXl2Deti2sH2wHxXfwgzrQzdBArX12fc-7rVNVzgleEtuTNLkzRK7cag4cVJqRrW_ygOieC1kteY_rwJD6rnqS0w5jRjvPH1VnNWsxLeF79vvTZDpPfKIfSlDSM2fbW2WwhoTCg3oVgUo6g9sim4FQ-5NfKG2sUSiPoGTrEsEfeekDbkEablUvIevQpFOZbpMbRWa2yDX4me_iJ1N-6fcF8G4P1OZW0QRHcDTRt7YhyOIVOSW3gafVoKPrw7Pguqq_v331Zf1xef_5wtb68XmpW87ysNceGdo0CImpNhWg7gkXHaW_oAEwL1rJeYBioxmV_TU2I6DotagXcNGKgi-rlQXd0IcnjvpMknHWYc1KUFtXVAWGC2skx2r2Kv2RQVt4kQtxIFbPVDqRgVPcc606Qthl6UNrUyjAYWE2Z0lC0Lo7Vpn4PRoPPUbl7ovd_vN3KTfghG0q7-bSL6vVRIIbvE6Qs97Yc1DnlIUyHvhvCKWsK9NU_0P9P1xxQOoaUIgx3zRAsZw_esuTsQXn0YKG9OB3kjnRrOvoH3Nnfpg</recordid><startdate>20150223</startdate><enddate>20150223</enddate><creator>Won, 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Gyo</au><au>Park, Yeon-Joon</au><au>Uh, Young</au><au>Kim, Shine-Young</au><au>Lee, Mi-Kyung</au><au>Kim, Soo Hyun</au><au>Shin, Myung Geun</au><au>Suh, Soon Pal</au><au>Ryang, Dong Wook</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Antifungal susceptibilities of bloodstream isolates of Candida species from nine hospitals in Korea: application of new antifungal breakpoints and relationship to antifungal usage</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2015-02-23</date><risdate>2015</risdate><volume>10</volume><issue>2</issue><spage>e0118770</spage><epage>e0118770</epage><pages>e0118770-e0118770</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>We applied the new clinical breakpoints (CBPs) of the Clinical and Laboratory Standards Institute (CLSI) to a multicenter study to determine the antifungal susceptibility of bloodstream infection (BSI) isolates of Candida species in Korea, and determined the relationship between the frequency of antifungal-resistant Candida BSI isolates and antifungal use at hospitals. Four hundred and fifty BSI isolates of Candida species were collected over a 1-year period in 2011 from nine hospitals. The susceptibilities of the isolates to four antifungal agents were determined using the CLSI M27 broth microdilution method. By applying the species-specific CBPs, non-susceptibility to fluconazole was found in 16.4% (70/428) of isolates, comprising 2.6% resistant and 13.8% susceptible-dose dependent isolates. However, non-susceptibility to voriconazole, caspofungin, or micafungin was found in 0% (0/370), 0% (0/437), or 0.5% (2/437) of the Candida BSI isolates, respectively. Of the 450 isolates, 72 (16.0%) showed decreased susceptibility to fluconazole [minimum inhibitory concentration (MIC) ≥4 μg/ml]. The total usage of systemic antifungals varied considerably among the hospitals, ranging from 190.0 to 7.7 defined daily dose per 1,000 patient days, and fluconazole was the most commonly prescribed agent (46.3%). By Spearman's correlation analysis, fluconazole usage did not show a significant correlation with the percentage of fluconazole resistant isolates at hospitals. However, fluconazole usage was significantly correlated with the percentage of fluconazole non-susceptible isolates (r = 0.733; P = 0.025) or the percentage of isolates with decreased susceptibility to fluconazole (MIC ≥4 μg/ml) (r = 0.700; P = 0.036) at hospitals. Our work represents the first South Korean multicenter study demonstrating an association between antifungal use and antifungal resistance among BSI isolates of Candida at hospitals using the new CBPs of the CLSI.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>25706866</pmid><doi>10.1371/journal.pone.0118770</doi><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2015-02, Vol.10 (2), p.e0118770-e0118770 |
| issn | 1932-6203 1932-6203 |
| language | eng |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Antifungal agents Antifungal Agents - pharmacology Breakpoints Candida Candida - drug effects Candida albicans Candida krusei Candida parapsilosis Caspofungin Correlation Correlation analysis Dosage Drug use Epidemiology Fluconazole Fungemia - microbiology Fungicides Hospitals Humans Identification Laboratories Medical schools Medicine Methods Micafungin Microbial Sensitivity Tests Minimum inhibitory concentration Patients Republic of Korea Species Studies Surveillance Voriconazole |
| title | Antifungal susceptibilities of bloodstream isolates of Candida species from nine hospitals in Korea: application of new antifungal breakpoints and relationship to antifungal usage |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-03T10%3A01%3A52IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Antifungal%20susceptibilities%20of%20bloodstream%20isolates%20of%20Candida%20species%20from%20nine%20hospitals%20in%20Korea:%20application%20of%20new%20antifungal%20breakpoints%20and%20relationship%20to%20antifungal%20usage&rft.jtitle=PloS%20one&rft.au=Won,%20Eun%20Jeong&rft.date=2015-02-23&rft.volume=10&rft.issue=2&rft.spage=e0118770&rft.epage=e0118770&rft.pages=e0118770-e0118770&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0118770&rft_dat=%3Cproquest_plos_%3E3602770241%3C/proquest_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1658066186&rft_id=info:pmid/25706866&rft_doaj_id=oai_doaj_org_article_953cb60c89174fbeacd2ad5ef5235ace&rfr_iscdi=true |