ArticlePLoS neglected tropical diseases2020
Decreasing fluconazole susceptibility of clinical South African Cryptococcus neoformans isolates over a decade.
Article in PLoS neglected tropical diseases, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 3 of them syntheses that pooled it.
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Who cites it
24 citing papers in PubMed, 3 syntheses or guidelines pooled it, 36 citations in OpenAlex.
- Global guideline for the diagnosis and management of cryptococcosis: an initiative of the ECMM and ISHAM in cooperation with the ASM.The Lancet. Infectious diseases · 2024Guideline
- Cryptococcosis-a systematic review to inform the World Health Organization Fungal Priority Pathogens List.Medical mycology · 2024Pooled it
- Pulmonary cryptococcosis complicated with pulmonary aspergillosis: a series of studies and a literature review.BMC infectious diseases · 2024Pooled it
- Trial
- A review of the current anti-New microbes and new infections · 2026Review
- Assessing the Anti-Cryptococcus Antifungal Potential of Artemisinin.International journal of molecular sciences · 2025Article
- Antifungal Activity of 8-Hydroxyquinoline Derivatives AgainstPathogens (Basel, Switzerland) · 2025Article
- Agricultural propiconazole residues promote triazole cross-resistance inAntimicrobial agents and chemotherapy · 2025Article
- Article
- Complex Decisions in HIV-Related Cryptococcosis: Addressing Second Episodes of Cryptococcal Meningitis.Current HIV/AIDS reports · 2024Review
- Fluconazole Resistance and Virulence in In Vitro Induced-Fluconazole Resistant Strains and in Clinical Fluconazole Resistant Strain ofPathogens (Basel, Switzerland) · 2023Article
- Exposure ofPathogens (Basel, Switzerland) · 2023Article
- Identification of four compounds from the Pharmakon library with antifungal activity against Candida auris and species of Cryptococcus.Medical mycology · 2022Article
- Molecular type distribution and fluconazole susceptibility of clinical Cryptococcus gattii isolates from South African laboratory-based surveillance, 2005-2013.PLoS neglected tropical diseases · 2022Article
- Lack of Association between Fluconazole Susceptibility andJournal of fungi (Basel, Switzerland) · 2022Article
- Commercial Methods for Antifungal Susceptibility Testing of Yeasts: Strengths and Limitations as Predictors of Resistance.Journal of fungi (Basel, Switzerland) · 2022Review
- Antifungal drug resistance: an update.European journal of hospital pharmacy : science and practice · 2022Article
- Collateral consequences of agricultural fungicides on pathogenic yeasts: A One Health perspective to tackle azole resistance.Mycoses · 2022Review
- Fungicide effects on human fungal pathogens: Cross-resistance to medical drugs and beyond.PLoS pathogens · 2021Review
- Genotype, Antifungal Susceptibility, and Virulence of Clinical South AfricanJournal of fungi (Basel, Switzerland) · 2021Article
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Authors and funding
13 authors at 1 institution in 1 country.
Funding
Abstract
backgroundFluconazole is used in combination with amphotericin B for induction treatment of cryptococcal meningitis and as monotherapy for consolidation and maintenance treatment. More than 90% of isolates from first episodes of cryptococcal disease had a fluconazole minimum inhibitory concentration (MIC) ≤4 μg/ml in a Gauteng population-based surveillance study of Cryptococcus neoformans in 2007-2008. We assessed whether fluconazole resistance had emerged in clinical cryptococcal isolates over a decade. METHODOLOGY AND PRINCIPAL
findingsWe prospectively collected C. neoformans isolates from 1 January through 31 March 2017 from persons with a first episode of culture-confirmed cryptococcal disease at 37 South African hospitals. Isolates were phenotypically confirmed to C. neoformans species-complex level. We determined fluconazole MICs (range: 0.125 μg/ml to 64 μg/ml) of 229 C. neoformans isolates using custom-made broth microdilution panels prepared, inoculated and read according to Clinical and Laboratory Standards Institute M27-A3 and M60 recommendations. These MIC values were compared to MICs of 249 isolates from earlier surveillance (2007-2008). Clinical data were collected from patients during both surveillance periods. There were more males (61% vs 39%) and more participants on combination induction antifungal treatment (92% vs 32%) in 2017 compared to 2007-2008. The fluconazole MIC50, MIC90 and geometric mean MIC was 4 μg/ml, 8 μg/ml and 4.11 μg/ml in 2017 (n = 229) compared to 1 μg/ml, 2 μg/ml and 2.08 μg/ml in 2007-2008 (n = 249) respectively. Voriconazole, itraconazole and posaconazole Etests were performed on 16 of 229 (7%) C. neoformans isolates with a fluconazole MIC value of ≥16 μg/ml; only one had MIC values of >32 μg/ml for these three antifungal agents. CONCLUSIONS AND SIGNIFICANCE: Fluconazole MIC50 and MIC90 values were two-fold higher in 2017 compared to 2007-2008. Although there are no breakpoints, higher fluconazole doses may be required to maintain efficacy of standard treatment regimens for cryptococcal meningitis.
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