{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T07:59:08Z","timestamp":1791273548245,"version":"4.1.0"},"reference-count":34,"publisher":"American Society for Microbiology","issue":"8","license":[{"start":{"date-parts":[[2013,8,1]],"date-time":"2013-08-01T00:00:00Z","timestamp":1375315200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Antimicrob Agents Chemother"],"published-print":{"date-parts":[[2013,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Mutations in\n                    <jats:italic>Candida glabrata FKS<\/jats:italic>\n                    genes, which encode the echinocandin target enzyme, are independent risk factors for treatment failures during invasive candidiasis. We retrospectively compared the ability of caspofungin susceptibility testing methods to identify\n                    <jats:named-content xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" content-type=\"genus-species\" xlink:type=\"simple\">C. glabrata<\/jats:named-content>\n                    <jats:italic>FKS<\/jats:italic>\n                    mutant isolates and predict outcomes among patients at our center. Eight percent (10\/120) of sterile-site\n                    <jats:named-content xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" content-type=\"genus-species\" xlink:type=\"simple\">C. glabrata<\/jats:named-content>\n                    isolates harbored\n                    <jats:italic>FKS1<\/jats:italic>\n                    (\n                    <jats:italic>n<\/jats:italic>\n                    = 3) or\n                    <jats:italic>FKS2<\/jats:italic>\n                    (\n                    <jats:italic>n<\/jats:italic>\n                    = 7) mutations, including 32% (10\/32) recovered from patients with prior echinocandin exposure. Median echinocandin exposures for mutant and nonmutant isolates were 55 (range, 7 to 188) and 13 (3 to 84) days, respectively (\n                    <jats:italic>P<\/jats:italic>\n                    = 0.004). Sensitivity and specificity of the CLSI caspofungin resistance breakpoint MIC (&gt;0.12 \u03bcg\/ml by broth microdilution using RPMI medium [BMD-RPMI]) were 90% (9\/10) and 3% (3\/110), respectively, for identifying\n                    <jats:italic>FKS<\/jats:italic>\n                    mutants. Sensitivity and specificity of receiver-operator characteristic (ROC) curve-derived breakpoints by BMD-RPMI, BMD-antibiotic medium 3, Etest, and YeastOne ranged from 70 to 100% and 89 to 95%, respectively; susceptibility rates varied from 83 to 90%. The 14-day echinocandin treatment success rate was 67% (44\/66); failure was more likely with prior echinocandin exposure (\n                    <jats:italic>P<\/jats:italic>\n                    = 0.002) or infection with an\n                    <jats:italic>FKS<\/jats:italic>\n                    mutant (\n                    <jats:italic>P<\/jats:italic>\n                    = 0.0001) or echinocandin-resistant isolates by BMD-AM3, Etest, and YeastOne (\n                    <jats:italic>P<\/jats:italic>\n                    \u2264 0.03). The failure rate among patients with prior exposure and infection with a resistant isolate was 91% (10\/11); it was 22% (12\/55) among others (\n                    <jats:italic>P<\/jats:italic>\n                    &lt; 0.0001). In conclusion, ROC-derived caspofungin MIC breakpoints by several methods were sensitive and specific for identifying\n                    <jats:named-content xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" content-type=\"genus-species\" xlink:type=\"simple\">C. glabrata<\/jats:named-content>\n                    <jats:italic>FKS<\/jats:italic>\n                    mutant isolates. Mutations were seen exclusively among patients with prior echinocandin exposure. A paradigm that considers prior echinocandin exposure and caspofungin MICs accurately classified treatment outcomes for\n                    <jats:named-content xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" content-type=\"genus-species\" xlink:type=\"simple\">C. glabrata<\/jats:named-content>\n                    invasive candidiasis.\n                  <\/jats:p>","DOI":"10.1128\/aac.00136-13","type":"journal-article","created":{"date-parts":[[2013,5,14]],"date-time":"2013-05-14T00:58:27Z","timestamp":1368493107000},"page":"3528-3535","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":101,"title":["Caspofungin MICs Correlate with Treatment Outcomes among Patients with Candida glabrata Invasive Candidiasis and Prior Echinocandin Exposure"],"prefix":"10.1128","volume":"57","author":[{"given":"Ryan K.","family":"Shields","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Hong","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen G.","family":"Press","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cassaundra L.","family":"Updike","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornelius J.","family":"Clancy","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA"},{"name":"VA Healthcare System Pittsburgh, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.01283-12"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1086\/596757"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00937-12"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00027-12"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.drup.2011.01.004"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.49.9.3616-3623.2005"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00566-08"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cit136"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01292-08"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01364-10"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00791-12"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.42.8.3475-3482.2004"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-0691.2007.01935.x"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.01840-06"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01256-09"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.49.4.1604-1607.2005"},{"key":"e_1_3_2_18_2","first-page":"257","article-title":"Comparison of microdilution method and E-test procedure in susceptibility testing of caspofungin against Candida non-albicans species","volume":"31","author":"Serefko A","year":"2008","unstructured":"SerefkoA LosR BiernasiukA MalmA. 2008. Comparison of microdilution method and E-test procedure in susceptibility testing of caspofungin against Candida non-albicans species. New Microbiol. 31:257\u2013262.","journal-title":"New Microbiol"},{"key":"e_1_3_2_19_2","volume-title":"Approved standard M27-A3","author":"Clinical and Laboratory Standards Institute","year":"2008","unstructured":"Clinical and Laboratory Standards Institute. 2008. Reference method for broth dilution antifungal susceptibility testing of yeasts. Approved standard M27-A3, 3rd ed. CLSI, Wayne, PA.","edition":"3"},{"key":"e_1_3_2_20_2","volume-title":"Third informational supplement","author":"Clinical and Laboratory Standards Institute","year":"2008","unstructured":"Clinical and Laboratory Standards Institute. 2008. Reference method for broth dilution antifungal susceptibility testing of yeasts. Third informational supplement, vol 28. 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