ArticlePloS one2014
The widely used ATB FUNGUS 3 automated readings in China and its misleading high MICs of Candida spp. to azoles: challenges for developing countries' clinical microbiology labs.
Article in PloS one, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it, 26 citations in OpenAlex.
- Antifungal resistance and poor clinical outcome rates ofFrontiers in microbiology · 2026Pooled it
- Epidemiology, antifungal susceptibility, risk factors, and mortality of adult candidemia at a tertiary hospital in Eastern China from 2020 to 2025.BMC infectious diseases · 2026Article
- Epidemiology of vulvovaginal candidiasis in China: a six-year retrospective single-center study from a tertiary obstetrics and gynecology hospital in Shanghai.Microbiology spectrum · 2026Article
- Species distribution and antifungal susceptibility of Candida isolates from sterile body sites: a 14-year retrospective study at a tertiary care hospital in China (2010-2023).BMC microbiology · 2026Observational
- Comparative evaluation of antifungal susceptibility testing methods of invasive Candida species and detection of FKS genes mutations in caspofungin intermediate and resistant isolates.BMC infectious diseases · 2025Article
- An AIE-active probe acts as novel tool for rapid and accurate quantitative antifungal susceptibility assessment.Frontiers in microbiology · 2025Article
- A cluster ofAntimicrobial stewardship & healthcare epidemiology : ASHE · 2024Article
- Epidemiology, species distribution, and outcome of nosocomial Candida spp. bloodstream infection in Shanghai: an 11-year retrospective analysis in a tertiary care hospital.Annals of clinical microbiology and antimicrobials · 2021Article
- Can We Improve Antifungal Susceptibility Testing?Frontiers in cellular and infection microbiology · 2021Review
- ALDH1A3 Regulations of Matricellular Proteins Promote Vascular Smooth Muscle Cell Proliferation.iScience · 2019Article
- Matrix-assisted laser desorption/ionization time-of-flight mass spectrometric identification and antifungal susceptibility analysis of Candida species isolated from patients with invasive yeast infections in five university hospitals.Brazilian journal of microbiology : [publication of the Brazilian Society for Microbiology] · 2019Article
- Strategies to Reduce Mortality in Adult and Neonatal Candidemia in Developing Countries.Journal of fungi (Basel, Switzerland) · 2017Review
- Multidrug-Resistant Candida auris Misidentified as Candida haemulonii: Characterization by Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry and DNA Sequencing and Its Antifungal Susceptibility Profile Variability by Vitek 2, CLSI Broth Microdilution, and Etest Method.Journal of clinical microbiology · 2015Article
- Overexpression of Both ERG11 and ABC2 Genes Might Be Responsible for Itraconazole Resistance in Clinical Isolates of Candida krusei.PloS one · 2015Article
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Authors and funding
8 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The rapid development in the clinical microbiology diagnostic assays presents more challenges for developing countries than for the developed world, especially in the area of test validation before the introduction of new tests. Here we report on the misleading high MICs of Candida spp. to azoles using the ATB FUNGUS 3 (bioMérieux, La Balme-les Grottes, France) with automated readings in China to highlight the dangers of introducing a diagnostic assay without validation. ATB FUNGUS 3 is the most commonly used commercial antifungal susceptibility testing method in China. An in-depth analysis of data showed higher levels of resistance to azoles when ATB FUNGUS 3 strips were read automatically than when read visually. Based on this finding, the performance of ATB FUNGUS 3, read both visually and automatically, was evaluated by testing 218 isolates of five clinically important Candida species, using broth microdilution (BMD) following CLSI M27-A3 as the gold-standard. The overall essential agreement (EA) between ATB visual readings and BMD was 99.1%. In contrast, the ATB automated readings showed higher discrepancies with BMD, with overall EA of 86.2%, and specifically lower EA was observed for fluconazole (80.7%), voriconazole (77.5%), and itraconazole (73.4%), which was most likely due to the trailing effect of azoles. The major errors in azole drug susceptibilities by ATB automated readings is a concern in China that can result in misleading clinical antifungal drug selection and pseudo high rates of antifungal resistance. Therefore, the ATB visual reading is generally recommended. In the meantime, we propose a practical algorithm to be followed for ATB FUNGUS 3 antifungal susceptibility for Candida spp. before the improvement in the automated reading system.
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