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Evaluation of the possible influence of trailing and paradoxical effects on the clinical outcome of patients with candidemia

2016; Elsevier BV; Volume: 23; Issue: 1 Linguagem: Inglês

10.1016/j.cmi.2016.09.016

1469-0691

Cristina Rueda, Mireia Puig‐Asensio, Jesús Guinea, Benito Almirante, Manuel Cuenca‐Estrella, Óscar Zaragoza, B. Padilla, Patricia Muñóz, Jesús Guinea, Julio Pardo, Julio García‐Rodríguez, Carlos García-Cerrada, Jesús Fortün, Peter Martin, Elia Gómez, Pablo Ryan, C. Campelo, Ignacio de los Santos, V. Buendía, B. Pérez Gorricho, Marta Alonso, Francisco Sanz, José María Aguado, Paloma Merino, Fernando González Romo, Miguel Górgolas, Ignacio Gadea, Juan Emilio Losa, Alberto Delgado‐Iribarren, António Ramos, Yolanda Romero, Isabel Sánchez Romero, Óscar Zaragoza, Manuel Cuenca‐Estrella, Jesús Rodríguez‐Baño, A. Isabel Suarez, Ana Loza, Alejandro García, Estrella Martín‐Mazuelos, Maite Ruiz Pérez de Pipaón, José Garnacho, Carlos Ortíz, Matheus Pedrotti Chavez, F.L. Maroto, M Salavert, Javier Pemán, José Blanquer, David Navarro, Juan J. Camarena, Rafael Zaragoza, Vicente Abril, Cristina Verdejo, Silvia Hernáez, Guillermo Ezpeleta, Elena Bereciartúa, J.L. Hernández Almaraz, Miguel Montejo, R.A. Rivas, R. Ayarza, Ana María Planes, Isabel Ruiz‐Camps, Benito Almirante, José Mensa, Manuel Almela, M. Gurguí, F Sánchez, Joaquin Martínez‐Montauti, Montserrat Sierra, Juan Pablo Horcajada, Luisa Sorlí, Juana Carretero Gómez, A. Gené, Mireya Urrea, Maricela Valerio, Ana Díaz‐Martín, Francesc Puchades Gimeno, Alessandra Mularoni,

Antifungal resistance and susceptibility

ObjectiveParadoxical growth (PG) and trailing effect (TE) are frequently observed during antifungal susceptibility testing (AFST). These two phenomena interfere with the determination of the minimal inhibitory concentration (MIC). The aim of this study was to assess the clinical impact of TE and PG.MethodsWe analysed the frequency of TE and PG of 690 Candida isolates collected from a population-based study performed in Spain (CANDIPOP) and correlated the results with clinical outcome of the patients.ResultsAround 70% (484/690) of the isolates exhibited TE to azoles. Candida tropicalis showed the highest presence of TE (39/53 isolates exhibited residual growth >25% of control). No TE was seen in most of the isolates from the psilosis complex. PG was mainly associated with echinocandins. In patients treated with fluconazole within the first 48 hours after blood sampling (n = 221), the presence of TE to azoles tended to be associated with lower 30-day mortality (odds ratio (OR) 0.55, 95% confidence interval (CI) 0.25–1.00) but not with clinical failure (OR 0.85, 95% CI 0.45–1.54). In the subgroup of 117 patients treated with echinocandins, the presence of PG was not associated with patient's response to antifungal treatment (OR for 30-day mortality 1.63, 95% CI 0.76–4.03; OR for clinical failure 1.17, 95% CI 0.53–2.70).ConclusionsTE or PG are widely expressed among Candida spp., although they do not seem to influence clinical outcome.