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Fluconazole resistance is not a predictor of poor outcome in patients with cryptococcosis
Author(s) -
Vena Antonio,
Muñoz Patricia,
Guinea Jesús,
Escribano Pilar,
Peláez Teresa,
Valerio Maricela,
Bonache Francisco,
Gago Sara,
ÁlvarezUría Ana,
Bouza Emilio
Publication year - 2019
Publication title -
mycoses
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.13
H-Index - 69
eISSN - 1439-0507
pISSN - 0933-7407
DOI - 10.1111/myc.12847
Subject(s) - fluconazole , cryptococcosis , cryptococcus neoformans , medicine , cryptococcus , antifungal , microbiology and biotechnology , biology , immunology , dermatology
Summary Background Cryptococcus isolates with high MIC s to fluconazole are increasingly reported, and a potential clinical impact has been advocated. However, there are different methods to evaluate fluconazole MIC s and comparative analysis among such techniques and their comprehensive correlation with clinical outcome are not available. Methods Over a 13‐year period (2000‐2013), fluconazole MIC s were determined for 62 cryptococcal isolates recovered from 22 patients with cryptococcosis using CLSI M27‐A3, EUCAST , E test and Sensititre YeastOne, simultaneously. The relationship between the fluconazole MIC s and the clinical outcome at week 10 was assessed in patients who received fluconazole as induction or maintenance therapy (n = 16). Results The percentage of cryptococcal strains with MIC values ≥16 μg/ mL according to different methods was CLSI 1.6%, EUCAST 16.1%, E test 31.6% and Sensititre YeastOne 53.2%. Among the 16 patients treated with fluconazole, no correlation between clinical outcome and any MIC value obtained with either method was observed. The only variable independently associated with a poor outcome was having a disseminated disease. Conclusions There is a weak correlation between fluconazole MIC s against Cryptococcus spp. as determined by CLSI , EUCAST , E test and Sensititre YeastOne. Neither procedure could predict the clinical outcome of patients with cryptococcosis receiving fluconazole‐based therapy. With present methods, fluconazole resistance in Cryptococcus may be clinically misleading.