Multicenter Italian Study on “In Vitro Activities” of Isavuconazole, Voriconazole, Amphotericin B, and Caspofungin for Aspergillus Species: Comparison between Sensititre^TM YeastOne^TM and MIC Test Strip

Figures & data

Table 1 MIC and MEC (µg/mL) Distributions for Aspergillus Species by SYO

Species	Total	Drug	0.015	0.03	0.06	0.12	0.25	0.5	1	2	4	8	16
Aspergillus fumigatus	128	Isavuconazole			1	10	58	53	5	1
		Voriconazole			3	8	93	22	1
		Amphotericin B							25	96	6	1
		Caspofungin MIC					1						86
		Caspofungin MEC		3	15	16	1			1	1	4
Aspergillus flavus	30	Isavuconazole					3	23	3	1
		Voriconazole					5	19	5	1
		Amphotericin B							3	22	5
		Caspofungin MIC											11
		Caspofungin MEC	2	12	5
Aspergillus terreus	32	Isavuconazole			1	20	8	3
		Voriconazole				20	10	2
		Amphotericin B							3	17	12
		Caspofungin MIC											7
		Caspofungin MEC		4	8	8	3		1			1
Aspergillus niger	25	Isavuconazole					3	2	13	6	1
		Voriconazole				1	18	4	2
		Amphotericin B						2	12	11
		Caspofungin MIC											13
		Caspofungin MEC	2	6	3	1
Other Aspergillus spp.	9	Isavuconazole			3	3		1	1	1
		Voriconazole			1	4	1	2		1
		Amphotericin B				1			1	2	3	2
		Caspofungin MIC								1			7
		Caspofungin MEC										2

Notes: The most frequent MIC/MEC obtained for different species are shown in bold.

Table 2 MIC and MEC (µg/mL) Distribution for Aspergillus Species by MIC Test Strip

Species	Total	Drug	0.016	0.023	0.032	0.047	0.064	0.094	0.125	0.19	0.25	0.38	0.5	0.75	1	1.5	2	3	4	6	8	12	32	>32	N.E.
Aspergillus fumigatus	128	Isavuconazole	1	1	1	4	4	19	33	40	19	6
		Voriconazole	1		2	2	3	12	17	48	24	16	1		1				1
		Amphotericin B								2	7	4	10	12	11	7	30	9	17	10	1	1		7
		Caspofungin MIC			1		3	5	11	18	29	12	3										4	1
		Caspofungin MEC				1	1	3	12	8	6	2												8
Aspergillus flavus	30	Isavuconazole					2	7	5	7	7	1	1
		Voriconazole					1		3	6	4	7	6	2											1
		Amphotericin B											1			1	3						3	3	19
		Caspofungin MIC					1	2	5		1								1				1
		Caspofungin MEC						1	8	4	2	1		1										1	1
Aspergillus terreus	32	Isavuconazole					1	2	6	5	7	7	1	3
		Voriconazole				1			1	2	3	4	3	11	3	4
		Amphotericin B												2	1	1	2	3	4	1	2			16
		Caspofungin MIC					2	2		2	1
		Caspofungin MEC				1		1	10	5	4													4
Aspergillus niger	25	Isavuconazole				1	1	3		2	6	4	2	5		1
		Voriconazole			1	1		2	4	4	2	3	2			1
		Amphotericin B							2	1	2		3	2	1	2	3	3		1					5
		Caspofungin MIC					1	2	4	3	1	1	1
		Caspofungin MEC						3	4																5
Other Aspergillus spp.	9	Isavuconazole	2	1	1	1	1								1		2
		Voriconazole	1		2	1	1		1			1	1				1
		Amphotericin B															1		1		4	1	2
		Caspofungin MIC						1	2		1	2									1
		Caspofungin MEC											1											1

Notes: The most frequent MIC/MEC obtained for different species are shown in bold.

Abbreviations: N.E., not evaluable.

Figure 1 Amphotericin MIC test strip with Aspergillus flavus.

Figure 2 Caspofungin MIC test strip with Aspergillus fumigatus (A) and Aspergillus terreus (B).

Table 3 Essential Agreement (EA) and MIC₅₀/MIC₉₀ (µg/mL) by Sensititre (SYO) and MIC Test Strip for the Most Clinically Relevant Aspergillus spp

Antifungals	Species		A. fumigatus	A. flavus	A. terreus	A. niger	All
Isavuconazole	N° isolates		128	30	32	25
	MIC Strip	MIC50	0.19	0.19	0.25	0.25
		MIC90	0.25	0.25	0.5	0.75
		MIC range	0.016–0.38	0.064–0.5	0.064–0.75	0.047–1.5
	SYO	MIC50	0.25	0.5	0.12	1
		MIC90	0.5	1	0.25	2
		MIC range	0.06–2	0.25–2	0.06–0.5	0.25–4
	EA	(%)	75.7	45.2	90.6	40	69.7
	ECV (CLSI)		≤1	≤1	≤1	≤4
	ECV (EUCAST)		≤2	≤2	≤1	≤4
Voriconazole	MIC Strip	MIC50	0.19	0.38	0.75	0.25
		MIC90	0.38	0.5	1.5	1.5
		MIC range	0.016–1	0.064–0.75	0.047–1.5	0.032–1.5
	E-test ECV*		0.5	0.5	n.a.	1
	SYO	MIC50	0.25	0.5	0.12	0.25
		MIC90	0.5	0.5	0.25	0.5
		MIC range	0.06–1	0.25–2	0.12–0.5	0.12–1
	EA	(%)	78.9	77.4	50	50	70.2
	SYO ECV*	µg/mL	≤1	≤1	n.a	≤1
	ECV (CLSI)	µg/mL	≤1	≤1	≤1	≤2
	ECV (EUCAST)	µg/mL	≤1	≤2	≤2	≤2
Amphotericin B	MIC Strip	MIC50	2	>32	8	1.5
		MIC90	6	>32	>32	3
		MIC range	0.19–>32	0.5–>32	0.75–>32	0.125–6
	E-test ECV*		2	8	16	2
	SYO	MIC50	2	2	2	1
		MIC90	2	4	4	2
		MIC range	1–8	1–4	1–4	0.5–2
	EA	(%)	67.2	12.9	34.4	55	52
	ECV (CLSI)		≤2	≤4	≤4	≤2
	ECV (EUCAST)		≤1	≤4	≤8	(≤0.5)
Caspofungin	MIC Strip	MIC50	0.19	0.125	0.125	0.125
		MIC90	0.38	0.75	0.25	0.25
		MIC range	0.032–0.5	0.064–>32	0.047–>8	0.064–0.5
	SYO	MIC50	>8	0.03	0.12	>8
		MIC90	>8	>8	>8	>8
		MIC range	0.03–16	0.015–16	0.03–16	0.015–16
	EA MEC**	(%)	73.2	47.4	50	50	63
	EA MIC**	(%)	5.8	18.2	0	0	7
	ECV (CLSI)		n.a	n.a	n.a	n.a
	ECV (EUCAST)		n.a.	n.a.	n.a.	n.a

Notes: CLSI and EUCAST epidemiological cut-off (ECV) (µg/mL) values for each antifungal are shown. ECV in brackets are Tentative. * Method-specific ECV only if available. ** For Caspofungin, essential agreements (EA) were separately calculated for MIC and MEC interpretation. Isavuconazole MIC are in blue boxes.

Abbreviation: n.a, not available.