{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T06:37:03Z","timestamp":1792132623822,"version":"4.4.0"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T00:00:00Z","timestamp":1753747200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100014471","name":"Mundipharma Research Limited","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100014471","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>As EUCAST epidemiological cut-off values (ECOFFs) are not yet established for Candida auris, a multicentre study was conducted to determined (ECOFF) of echinocandins, amphotericin B and flucytosine using a global collection of C. auris isolates.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>MIC testing was performed in five centres according to the E.Def 7.4 reference methodology for anidulafungin, micafungin, amphotericin B and flucytosine using standard medium, and for rezafungin using standard medium supplemented with 0.002% Tween 20 as per protocol. A geographically diverse collection of 30 clinical C. auris strains with distinct short tandem repeat genotypes belonging to five different clades was tested. MIC distributions were constructed, and ECOFFs were determined on the basis of qualifying distributions according to EUCAST SOP 10.2 and using the ECOFFinder software, derivatization method and visual inspection.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The centre-specific modal MICs were: 0.008\u20130.03\u2005mg\/L for rezafungin, 0.016\u20130.06\u2005mg\/L for anidulafungin, 0.03\u20130.06\u2005mg\/L for micafungin, 0.5\u20131\u2005mg\/L for amphotericin B and 0.125\u20130.25\u2005mg\/L for flucytosine, and all complied with the EUCAST criterion of being within \u00b11 2-fold dilution from the most common modal MIC. Consensus EUCAST ECOFFs of 0.125\u2005mg\/L for rezafungin, 0.25\u2005mg\/L for anidulafungin and micafungin, 0.5\u2005mg\/L for flucytosine and 2\u2005mg\/L for amphotericin B were established.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>EUCAST ECOFFs have been determined for rezafungin, anidulafungin, micafungin, amphotericin B and flucytosine. They can be adopted to identify non-wild-type isolates and assist clinical breakpoint setting in the future when clinical outcome-MIC data are available.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jac\/dkaf241","type":"journal-article","created":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T15:32:14Z","timestamp":1753803134000},"page":"2459-2465","source":"Crossref","is-referenced-by-count":5,"title":["A multicentre study for determination of epidemiological cut-off values for <i>Candida auris<\/i> with EUCAST broth microdilution reference methodology"],"prefix":"10.1093","volume":"80","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8869-1509","authenticated-orcid":false,"given":"Joseph","family":"Meletiadis","sequence":"first","affiliation":[{"name":"Clinical Microbiology Laboratory, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens , Athens ,","place":["Greece"]},{"name":"Unit for Mycology, Statens Serum Institute , Copenhagen ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7901-8355","authenticated-orcid":false,"given":"Jesus","family":"Guinea","sequence":"additional","affiliation":[{"name":"Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Mara\u00f1\u00f3n , Madrid ,","place":["Spain"]},{"name":"Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Mara\u00f1\u00f3n e Instituto de Investigaci\u00f3n Sanitaria Gregorio Mara\u00f1\u00f3n , Madrid ,","place":["Spain"]},{"name":"CIBER Enfermedades Respiratorias-CIBERES (CB06\/06\/0058) , Madrid ,","place":["Spain"]},{"name":"Faculty of Health Sciences\u2014HM Hospitals, Universidad Camilo Jos\u00e9 Cela , Madrid ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9807-6764","authenticated-orcid":false,"given":"Sevtap","family":"Arikan-Akdagli","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, Hacettepe University School of Medicine , S\u0131hhiye Ankara ,","place":["Turkey"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eelco F J","family":"Meijer","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology and Immunology, Canisius-Wilhelmina Hospital (CWZ)\/Dicoon , Nijmegen ,","place":["The Netherlands"]},{"name":"Radboudumc-CWZ Center of Expertise for Mycology , Nijmegen ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3253-6080","authenticated-orcid":false,"given":"Jacques F","family":"Meis","sequence":"additional","affiliation":[{"name":"Radboudumc-CWZ Center of Expertise for Mycology , Nijmegen ,","place":["The Netherlands"]},{"name":"Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne , Cologne ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4747-0144","authenticated-orcid":false,"given":"Maiken Cavling","family":"Arendrup","sequence":"additional","affiliation":[{"name":"Unit for Mycology, Statens Serum Institute , Copenhagen ,","place":["Denmark"]},{"name":"Department of Clinical Microbiology, University Hospital Rigshospitalet , Copenhagen ,","place":["Denmark"]},{"name":"Department of Clinical Medicine, University of Copenhagen , Copenhagen ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,7,29]]},"reference":[{"key":"2025090219523288500_dkaf241-B1","author":"WHO","year":"2022"},{"key":"2025090219523288500_dkaf241-B2","doi-asserted-by":"publisher","first-page":"489","DOI":"10.7326\/M22-3469","article-title":"Worsening spread of Candida auris in the United States, 2019 to 2021","volume":"176","author":"Lyman","year":"2023","journal-title":"Ann Intern Med"},{"key":"2025090219523288500_dkaf241-B3","doi-asserted-by":"publisher","first-page":"2200846","DOI":"10.2807\/1560-7917.ES.2022.27.46.2200846","article-title":"Increasing number of cases and outbreaks caused by Candida auris in the EU\/EEA, 2020 to 2021","volume":"27","author":"Kohlenberg","year":"2022","journal-title":"Euro Surveill"},{"key":"2025090219523288500_dkaf241-B4","author":"CDC"},{"key":"2025090219523288500_dkaf241-B5","doi-asserted-by":"publisher","first-page":"1083.e1","DOI":"10.1016\/j.cmi.2023.04.025","article-title":"Molecular characterization of Candida auris outbreak isolates in Qatar from patients with COVID-19 reveals the emergence of isolates resistant to three classes of antifungal drugs","volume":"29","author":"Ben Abid","year":"2023","journal-title":"Clin Microbiol Infect"},{"key":"2025090219523288500_dkaf241-B6","doi-asserted-by":"publisher","first-page":"e0005322","DOI":"10.1128\/aac.00053-22","article-title":"Candida auris pan-drug-resistant to four classes of antifungal agents","volume":"66","author":"Jacobs","year":"2022","journal-title":"Antimicrob Agents Chemother"},{"key":"2025090219523288500_dkaf241-B7","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1093\/mmy\/myae042","article-title":"Candida auris\u2014a systematic review to inform the world health organization fungal priority pathogens list","volume":"62","author":"Kim","year":"2024","journal-title":"Med Mycol"},{"key":"2025090219523288500_dkaf241-B8","doi-asserted-by":"publisher","first-page":"2400128","DOI":"10.2807\/1560-7917.ES.2024.29.45.2400128","article-title":"Candida auris fungaemia outbreak in a tertiary care academic hospital and emergence of a pan-echinocandin resistant isolate, Greece, 2021 to 2023","volume":"29","author":"Meletiadis","year":"2024","journal-title":"Euro Surveill"},{"key":"2025090219523288500_dkaf241-B9","doi-asserted-by":"publisher","first-page":"2300161","DOI":"10.2807\/1560-7917.ES.2023.28.14.2300161","article-title":"In vivo evolution to echinocandin resistance and increasing clonal heterogeneity in Candida auris during a difficult-to-control hospital outbreak, Italy, 2019 to 2022","volume":"28","author":"Codda","year":"2023","journal-title":"Euro Surveill"},{"key":"2025090219523288500_dkaf241-B10","doi-asserted-by":"publisher","first-page":"1079","DOI":"10.1111\/myc.13655","article-title":"Whole genome sequencing analysis demonstrates therapy-induced echinocandin resistance in Candida auris isolates","volume":"66","author":"Spruijtenburg","year":"2023","journal-title":"Mycoses"},{"key":"2025090219523288500_dkaf241-B11","doi-asserted-by":"publisher","first-page":"838","DOI":"10.1016\/j.cmi.2021.11.024","article-title":"In vivo emergence of high-level resistance during treatment reveals the first identified mechanism of amphotericin B resistance in Candida auris","volume":"28","author":"Rybak","year":"2022","journal-title":"Clin Microbiol Infect"},{"key":"2025090219523288500_dkaf241-B12","doi-asserted-by":"publisher","first-page":"757835","DOI":"10.3389\/fmicb.2021.757835","article-title":"So many diagnostic tests, so little time: review and preview of Candida auris testing in clinical and public health laboratories","volume":"12","author":"Dennis","year":"2021","journal-title":"Front Microbiol"},{"key":"2025090219523288500_dkaf241-B13","author":"CDC"},{"key":"2025090219523288500_dkaf241-B14","author":"CLSI","year":"2022"},{"key":"2025090219523288500_dkaf241-B15","doi-asserted-by":"publisher","first-page":"e70001","DOI":"10.1111\/myc.70001","article-title":"The in vitro activity of rezafungin against uncommon species of Candida","volume":"67","author":"Winkler","year":"2024","journal-title":"Mycoses"},{"key":"2025090219523288500_dkaf241-B16","author":"Arendrup"},{"key":"2025090219523288500_dkaf241-B17","doi-asserted-by":"publisher","first-page":"1102","DOI":"10.1093\/jac\/dkad055","article-title":"Development and preliminary validation of a modified EUCAST yeast broth microdilution MIC method with Tween 20-supplemented medium for rezafungin","volume":"78","author":"Zuill","year":"2023","journal-title":"J Antimicrob Chemother"},{"key":"2025090219523288500_dkaf241-B18","author":"ISO20776-1:2006"},{"key":"2025090219523288500_dkaf241-B19","author":"EUCAST (European Committee on Antimicrobial Susceptibility Testing)"},{"key":"2025090219523288500_dkaf241-B20","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2025.07.002","article-title":"How to interpret MICs of amphotericin B, echinocandins and flucytosine against Candida auris (Candidozyma auris) according to the newly established EUCAST breakpoints","author":"Arendrup","year":"2025","journal-title":"Clin Microbiol Infect"},{"key":"2025090219523288500_dkaf241-B21","doi-asserted-by":"publisher","first-page":"e00485-17","DOI":"10.1128\/AAC.00485-17","article-title":"Comparison of EUCAST and CLSI reference microdilution MICs of eight antifungal compounds for Candida auris and associated tentative epidemiological cutoff values","volume":"61","author":"Arendrup","year":"2017","journal-title":"Antimicrob Agents Chemother"},{"key":"2025090219523288500_dkaf241-B22","doi-asserted-by":"publisher","first-page":"599","DOI":"10.1093\/infdis\/jiad583","article-title":"Defining optimal doses of liposomal amphotericin B against Candida auris: data from an in vitro pharmacokinetic-pharmacodynamic model","volume":"229","author":"Beredaki","year":"2024","journal-title":"J Infect Dis"},{"key":"2025090219523288500_dkaf241-B23","doi-asserted-by":"publisher","first-page":"e00306-21","DOI":"10.1128\/AAC.00306-21","article-title":"In vitro and in vivo antifungal activity of AmBisome compared to conventional Amphotericin B and fluconazole against Candida auris","volume":"65","author":"Herrada","year":"2021","journal-title":"Antimicrob Agents Chemother"},{"key":"2025090219523288500_dkaf241-B24","doi-asserted-by":"publisher","first-page":"e00791-17","DOI":"10.1128\/AAC.00791-17","article-title":"Pharmacodynamic optimization for treatment of invasive Candida auris infection","volume":"61","author":"Lepak","year":"2017","journal-title":"Antimicrob Agents Chemother"},{"key":"2025090219523288500_dkaf241-B25","doi-asserted-by":"publisher","first-page":"e0152823","DOI":"10.1128\/jcm.01528-23","article-title":"Evaluation of the Vitek 2 system for antifungal susceptibility testing of Candida auris using a representative international panel of clinical isolates: overestimation of amphotericin B resistance and underestimation of fluconazole resistance","volume":"62","author":"Siopi","year":"2024","journal-title":"J Clin Microbiol"},{"key":"2025090219523288500_dkaf241-B26","doi-asserted-by":"publisher","first-page":"e0443122","DOI":"10.1128\/spectrum.04431-22","article-title":"Overestimation of Amphotericin B resistance in Candida auris with sensititre YeastOne antifungal susceptibility testing: a need for adjustment for correct interpretation","volume":"11","author":"Siopi","year":"2023","journal-title":"Microbiol Spectr"},{"key":"2025090219523288500_dkaf241-B27","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1016\/j.cmi.2024.10.010","article-title":"Candida auris MIC testing by EUCAST and clinical and laboratory standards institute broth microdilution, and gradient diffusion strips; to be or not to be amphotericin B resistant?","volume":"31","author":"Arendrup","year":"2025","journal-title":"Clin Microbiol Infect"},{"key":"2025090219523288500_dkaf241-B28","doi-asserted-by":"publisher","first-page":"840","DOI":"10.3390\/antibiotics13090840","article-title":"Evaluation of Etest and MICRONAUT-AM assay for antifungal susceptibility testing of Candida auris: underestimation of fluconazole resistance by MICRONAUT-AM and overestimation of Amphotericin B resistance by Etest","volume":"13","author":"Asadzadeh","year":"2024","journal-title":"Antibiot (Basel, Switzerland)"},{"key":"2025090219523288500_dkaf241-B29","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3390\/antibiotics9090568","article-title":"Antifungal resistance in Candida auris: molecular determinants","volume":"9","author":"Fr\u00edas-De-le\u00f3n","year":"2020","journal-title":"Antibiotics"},{"key":"2025090219523288500_dkaf241-B30","doi-asserted-by":"publisher","first-page":"3304","DOI":"10.1038\/s41564-024-01854-z","article-title":"Acquired amphotericin B resistance leads to fitness trade-offs that can be mitigated by compensatory evolution in Candida auris","volume":"9","author":"Carolus","year":"2024","journal-title":"Nat Microbiol"},{"key":"2025090219523288500_dkaf241-B31","doi-asserted-by":"publisher","first-page":"e0165221","DOI":"10.1128\/AAC.01652-21","article-title":"Impact of FKS1 genotype on echinocandin in vitro susceptibility in Candida auris and in vivo response in a murine model of infection","volume":"66","author":"Sharma","year":"2022","journal-title":"Antimicrob Agents Chemother"}],"container-title":["Journal of Antimicrobial Chemotherapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jac\/article-pdf\/80\/9\/2459\/63878504\/dkaf241.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jac\/article-pdf\/80\/9\/2459\/63878504\/dkaf241.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T23:52:36Z","timestamp":1756857156000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jac\/article\/80\/9\/2459\/8217003"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,29]]},"references-count":31,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,7,29]]},"published-print":{"date-parts":[[2025,9,3]]}},"URL":"https:\/\/doi.org\/10.1093\/jac\/dkaf241","relation":{},"ISSN":["0305-7453","1460-2091"],"issn-type":[{"value":"0305-7453","type":"print"},{"value":"1460-2091","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,9]]},"published":{"date-parts":[[2025,7,29]]}}}