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Shocking Information About AG-221


div>Indeed, many discrepancies could have been expected. Although all isolates were recovered from blood, the species were more varied than in many studies. The experience of the technicians reading the Etest could differ between laboratories, and the protracted study length of >3?years may have involved different technicians over time, with a possible drift in the readings. Although the Etest is easy to perform, the isolate/species�Cantifungal combination may affect the zone edge at the MIC intersection, with a trailing effect being seen with some isolates (about 20% of yeasts), and particularly with the azoles. Despite these issues, the present study even shows that the Etest identified most of the in?vitro resistant isolates and that Etest results were comparable to those achieved by EUCAST procedures. Succimer Nevertheless, we observed differences in percentage of agreement among hospitals, and this may lead to interest in regular quality controls, using the EUCAST method as a reference. This might be particularly useful for the three antifungals used to treat candidaemia (i.e. amphotericin?B, fluconazole, and caspofungin), for which agreement between the Etest and EUCAST methods was <80%. Categorical RSL3 cost agreement is more clinically relevant than global agreement, as these results can lead to treatment modifications [24]. This requires the definition of interpretive breakpoints, which have yet to be established for most antifungals, and more specifically, for new ones AG-221 in vivo such as caspofungin [5,6]. In this study, the azole with the most minor and major errors was itraconazole (31.3% and 9.1%, respectively), as previously reported [11]. This is probably not an issue, as itraconazole is not approved or used for yeast fungaemia. Very major discrepancies were observed only once (0.2%), with amphotericin?B, probably owing to the small number of true amphotericin?B-resistant isolates, which are usually more easily revealed by the Etest than by broth microdilution techniques [25,26]. For azoles, the very major errors were observed for fluconazole and voriconazole, and mainly for a few species, i.e. C.?glabrata, C.?guilliermondii and C.?tropicalis in the present study, as previously reported for fluconazole against C.?tropicalis [15]. It is of note that nine of the 45 isolates gave very major errors with both azoles, suggesting that these discrepancies are related to the isolates themselves and not to a technical problem. These very major errors might derive from the trailing growth observed with the Etest [27]. The trailing growth could generate higher MIC values than the EUCAST method, as shown in Fig.?1, explaining minor and major discrepancies, but not very major ones. Irrespective of the explanations, major and very major discrepancies occurred in <12% and 6%, respectively.

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