TABLE 5

Major clinical studies reporting antifungal susceptibility testing of Cryptococcus gattii against fluconazole c

ReferenceOrigin(s) of isolatesTotal no. of isolatesSource (no.) of isolatesModal MIC (mg/liter) a MIC90 (mg/liter)GM MIC (mg/liter)MIC range (mg/liter)% of isolates with MIC ≥ 32 mg/literDescription
29 Australia18C416NS0.5–6411Primarily VGI isolates
75 Taiwan21C816NS0.125–160 C. gattii was less susceptible to AMB and 5FC than C. neoformans; all C. gattii isolates were FLU susceptible
403 South America11CNSNSNS8–160High degree of susceptibility to AMB, 5FC, FLU, ITC
370 Spain57C (52)NS329.541–64NS C. gattii was less susceptible than C. neoformans to FLU but not AMB and 5FC
E (5)
368 Spain30C (mainly)NSNS0.7–10.25–20Overall low-level resistance; MICs for FLU were higher for C. gattii than for C. neoformans (P = 0.007)
404 Brazil23CNS25.615.524–>64NSAll strains had low MICs of AMB (0.03–0.25 mg/liter); among azoles, POS had greatest activity, followed by VOR, ITC, and FLU
366 USA35C (NS)NS0.0640.030.03–0.060Highly susceptible to isavuconazole
E (NS) 0.060.0270.015–0.250
363 Worldwide42C (NS)NS42.360.25–64 Few differences in susceptibility between C. gattii and C. neoformans
E (NS)
371 USA43C4166.380.5–320.05VGII molecular type strains, especially those of VGIIc, had highest FLU MICs
375 Australia, USA, Canada45C (NS) and E (NS); study INS83.541–80 C. gattii less susceptible than C. neoformans; strains of the VGII molecular type had significantly higher MICs for 5FC and all azoles, especially FLU
103Extended studyNS84.961–32NS
373 Worldwide350C (215)NS83.5730.25–64NSVeterinary isolates were least susceptible to ITC, POS, VRC, and ISA; MICs varied with molecular type for FLU and 5FC
367 India62C (2) 1.91.551–160VGI; C. gattii less susceptible than C. neoformans to FLU, ITC, and VRC but not AMB and 5FC; E was less susceptible than C and more resistant than C
E (60)NS88 0
405 Brazil13CNSNSNS16–>6415VGII molecular type studied
372 Brazil49C (43) and E (6); VGII 166.080.25–>64NSVGII molecular type strains less susceptible to FLU, VRC, and 5FC than VGI strains
VGI 41.551–80
359 Global298C and E (NS)8165.510.5–3220Molecular type VGII strains had the highest FLU GM MICs, and molecular type VGI had the lowest (8.6 vs 1.7 mg/liter)
406 Brazil54C (50)NS16NS1–64NSMainly molecular type VGII strains
E (4)
369 Brazil8CNS3213.458–320Susceptible to most drugs; no differences in susceptibility between C. neoformans and C. gattii; ECV = 32 mg/liter
374 Canada, USA90C (75)484.52–64NSMolecular type VGII studied, of which types IIb and IIc were less susceptible
E (15)
376 b Brazil24NS≤14NS<0.12–3233 isolates with MIC of 32 mg/liter; no molecular type stated
  • a In some instances, calculated by the authors.

  • b Measured by flow cytometry.

  • c Abbreviations: AMB, amphotericin B; C, clinical strains; E, environmental; 5FC, 5-flucytosine; FLU, fluconazole; GM, geometric mean; ITC, itraconazole; ISA, isavuconazole; POS, posaconazole; NS, not specified; VRC, voriconazole.