دورية أكاديمية
Decreasing fluconazole susceptibility of clinical South African Cryptococcus neoformans isolates over a decade.
| العنوان: | Decreasing fluconazole susceptibility of clinical South African Cryptococcus neoformans isolates over a decade. |
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| المؤلفون: | Serisha D Naicker, Ruth S Mpembe, Tsidiso G Maphanga, Thokozile G Zulu, Daniel Desanto, Jeannette Wadula, Nomonde Mvelase, Caroline Maluleka, Kessendri Reddy, Halima Dawood, Motlatji Maloba, Nelesh P Govender, for GERMS-SA |
| المصدر: | PLoS Neglected Tropical Diseases, Vol 14, Iss 3, p e0008137 (2020) |
| بيانات النشر: | Public Library of Science (PLoS), 2020. |
| سنة النشر: | 2020 |
| المجموعة: | LCC:Arctic medicine. Tropical medicine LCC:Public aspects of medicine |
| مصطلحات موضوعية: | Arctic medicine. Tropical medicine, RC955-962, Public aspects of medicine, RA1-1270 |
| الوصف: | BackgroundFluconazole is used in combination with amphotericin B for induction treatment of cryptococcal meningitis and as monotherapy for consolidation and maintenance treatment. More than 90% of isolates from first episodes of cryptococcal disease had a fluconazole minimum inhibitory concentration (MIC) ≤4 μg/ml in a Gauteng population-based surveillance study of Cryptococcus neoformans in 2007-2008. We assessed whether fluconazole resistance had emerged in clinical cryptococcal isolates over a decade.Methodology and principal findingsWe prospectively collected C. neoformans isolates from 1 January through 31 March 2017 from persons with a first episode of culture-confirmed cryptococcal disease at 37 South African hospitals. Isolates were phenotypically confirmed to C. neoformans species-complex level. We determined fluconazole MICs (range: 0.125 μg/ml to 64 μg/ml) of 229 C. neoformans isolates using custom-made broth microdilution panels prepared, inoculated and read according to Clinical and Laboratory Standards Institute M27-A3 and M60 recommendations. These MIC values were compared to MICs of 249 isolates from earlier surveillance (2007-2008). Clinical data were collected from patients during both surveillance periods. There were more males (61% vs 39%) and more participants on combination induction antifungal treatment (92% vs 32%) in 2017 compared to 2007-2008. The fluconazole MIC50, MIC90 and geometric mean MIC was 4 μg/ml, 8 μg/ml and 4.11 μg/ml in 2017 (n = 229) compared to 1 μg/ml, 2 μg/ml and 2.08 μg/ml in 2007-2008 (n = 249) respectively. Voriconazole, itraconazole and posaconazole Etests were performed on 16 of 229 (7%) C. neoformans isolates with a fluconazole MIC value of ≥16 μg/ml; only one had MIC values of >32 μg/ml for these three antifungal agents.Conclusions and significanceFluconazole MIC50 and MIC90 values were two-fold higher in 2017 compared to 2007-2008. Although there are no breakpoints, higher fluconazole doses may be required to maintain efficacy of standard treatment regimens for cryptococcal meningitis. |
| نوع الوثيقة: | article |
| وصف الملف: | electronic resource |
| اللغة: | English |
| تدمد: | 1935-2727 1935-2735 |
| Relation: | https://doaj.org/toc/1935-2727; https://doaj.org/toc/1935-2735 |
| DOI: | 10.1371/journal.pntd.0008137 |
| URL الوصول: | https://doaj.org/article/405ac15176bf4ce3b61a7e5b181e66b3 |
| رقم الأكسشن: | edsdoj.405ac15176bf4ce3b61a7e5b181e66b3 |
| قاعدة البيانات: | Directory of Open Access Journals |
Full Text Finder | تدمد: | 19352727 19352735 |
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| DOI: | 10.1371/journal.pntd.0008137 |