{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:27:26Z","timestamp":1792787246440,"version":"4.5.0"},"reference-count":33,"publisher":"American Society for Microbiology","issue":"8","license":[{"start":{"date-parts":[[2024,8,6]],"date-time":"2024-08-06T00:00:00Z","timestamp":1722902400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2024,8,6]],"date-time":"2024-08-06T00:00:00Z","timestamp":1722902400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"DOI":"10.13039\/501100001809","name":"MOST | National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["Grant No. 82002255"],"award-info":[{"award-number":["Grant No. 82002255"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"name":"CSTC | Natural Science Foundation of Chongqing Municipality","award":["Grant No. CSTB2023NSCQ-MSX0179,cstc2021jcyj-msxmX0217,No. cstc2020jcyj-msxmX0519"],"award-info":[{"award-number":["Grant No. CSTB2023NSCQ-MSX0179,cstc2021jcyj-msxmX0217,No. cstc2020jcyj-msxmX0519"]}]},{"name":"CQMHC | Science-Health Joint Medical Scientific Research Project of Chongqing","award":["Grant No. 2022QNXM002"],"award-info":[{"award-number":["Grant No. 2022QNXM002"]}]},{"DOI":"10.13039\/100012494","name":"Chongqing Municipal Education Commission Foundation","doi-asserted-by":"crossref","award":["Grant No. CYS20191"],"award-info":[{"award-number":["Grant No. CYS20191"]}],"id":[{"id":"10.13039\/100012494","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"published-print":{"date-parts":[[2024,8,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      Cryptococcal meningitis (CM), a common and serious opportunistic infection mostly caused by\n                      <jats:italic>Cryptococcus neoformans<\/jats:italic>\n                      , is primarily treated with fluconazole. Nevertheless,\n                      <jats:italic>Cryptococcus neoformans<\/jats:italic>\n                      strains that undergo repeated exposure to azoles can gradually acquire heteroresistance to fluconazole. The management of this specific CM infection poses a substantial challenge. Determining a globally accepted definition for fluconazole heteroresistance and developing effective and prompt methods for identifying heteroresistance is of utmost importance. We collected data on the clinical and epidemiological characteristics of patients diagnosed with CM. All the available\n                      <jats:italic>Cryptococcus neoformans<\/jats:italic>\n                      strains isolated from these patients were collected and subjected to antifungal susceptibility testing and evaluation of fluconazole heteroresistance. AIDS was present in 40.5% of the patients, whereas 24.1% did not have any underlying diseases. Patients with chronic diseases or impaired immune systems are susceptible to infection by\n                      <jats:italic>Cryptococcus neoformans<\/jats:italic>\n                      , a fungus that frequently (39.6%, 19\/48) shows heteroresistance to fluconazole, as confirmed by population analysis profile (PAP).\n                    <\/jats:p>\n                    <jats:sec>\n                      <jats:title>IMPORTANCE<\/jats:title>\n                      <jats:p>Fluconazole heteroresistance poses a significant threat to the efficacy of fluconazole in treating cryptococcal meningitis (CM). Unfortunately, the standard broth microdilution method often misses the subtle percentages of subpopulations exhibiting heteroresistance. While the population analysis profile (PAP) method is esteemed as the gold standard, its time-consuming and labor-intensive nature makes it impractical for routine clinical use. In contrast, the Kirby-Bauer (KB) disk diffusion method offers a simple and effective screening solution. Our study highlights the value of KB over PAP and minimum inhibitory concentration (MIC) by demonstrating that when adjusting the inoculum concentration to 1.0 McFarland and subjecting samples to a 72-hour incubation period at 35\u00b0C, the KB method closely mirrors the outcomes of the PAP approach in detecting fluconazole heteroresistance. This optimization of the KB method not only enhances assay efficiency but also provides a blueprint for developing a timely and effective strategy for identifying heteroresistance.<\/jats:p>\n                    <\/jats:sec>\n                  <\/jats:sec>","DOI":"10.1128\/spectrum.00725-24","type":"journal-article","created":{"date-parts":[[2024,7,15]],"date-time":"2024-07-15T09:42:41Z","timestamp":1721036561000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":13,"title":["Epidemiology of cryptococcal meningitis and fluconazole heteroresistance in\n                    <i>Cryptococcus neoformans<\/i>\n                    isolates from a teaching hospital in southwestern China"],"prefix":"10.1128","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6688-4269","authenticated-orcid":false,"given":"Yunfei","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Clinical Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongqi","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuangshuang","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongling","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanbing","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Fujian Key Clinical Specialty of Laboratory Medicine, Women and Children\u2019s Hospital, School of Medicine, Xiamen University, Xiamen, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingyue","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaojiong","family":"Jia","sequence":"additional","affiliation":[{"name":"Division of Allergy and Clinical Immunology, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dijiao","family":"Tang","sequence":"additional","affiliation":[{"name":"Department 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