Affiliation:
1. Departments of Pathology
2. Medicine, Roy J. and Lucille A. Carver College of Medicine, and College of Public Health, University of Iowa, Iowa City, Iowa 52242
3. Epidemiology
Abstract
ABSTRACT
Micafungin is a new echinocandin exhibiting broad-spectrum activity against
Candida
spp. The activity of the echinocandins against
Candida
species known to express intrinsic or acquired resistance to fluconazole is of interest. We determined the MICs of micafungin and caspofungin against 315 invasive clinical (bloodstream and other sterile-site) isolates of fluconazole-resistant
Candida
species obtained from geographically diverse medical centers between 2001 and 2004. MICs were determined using broth microdilution according to the CLSI reference method M27-A2. RPMI 1640 was used as the test medium, and we used the MIC endpoint of prominent growth reduction at 24 h. Among the 315 fluconazole-resistant
Candida
isolates, 146 (46%) were
C. krusei
, 110 (35%) were
C. glabrata
, 41 (13%) were
C. albicans
, and 18 (6%) were less frequently isolated species. Micafungin had good in vitro activity against all fluconazole-resistant
Candida
spp. tested; the MICs at which 50% (MIC
50
) and 90% (MIC
90
) of isolates were inhibited were 0.03 μg/ml and 0.06 μg/ml, respectively. All the fluconazole-resistant
Candida
spp. were inhibited at a micafungin MIC that was ≤1 μg/ml. Among the most common fluconazole-resistant
Candida
spp. tested in the collection,
C. glabrata
exhibited the lowest micafungin MICs (MIC
90
, ≤0.015 μg/ml), followed by
C. albicans
(MIC
90
, 0.03 μg/ml) and
C. krusei
(MIC
90
, 0.06 μg/ml). The new echinocandin micafungin has excellent in vitro activity against 315 invasive clinical isolates of fluconazole-resistant
Candida
, which represents the largest collection to date of fluconazole-resistant
Candida
isolates tested against micafungin. Micafungin may prove useful in the treatment of infections due to azole-resistant
Candida
.
Publisher
American Society for Microbiology
Cited by
82 articles.
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