As part of the 2024 Vivli AMR Surveillance Data Challenge , we explored antifungal suceptibility testing data for fungal isolates collected for pharmaceutical surveillance.
Explore summaries of MICs by species and antifungal, stratified by additional covariates such as Age, Gender, and WHO Region, over time and region/country, and visualize mic distributions.
For fungi that have established Clinical and Laboratory Standards Institute (CLSI) breakpoints, we analysed the percent of resistant isolates by antifungal, year, and World Health Organization (WHO) region. For fungi that have established CLSI Epidemiological cut-off values, we analyzed the percent of non-wildtype isolates (percent of isolates above the ECV) by antifungal, year, and World Health Organization (WHO) region. For fungi without ECVs, we determined the modal MICs by antifungal, year, and WHO region.
We used the Antimicrobial Testing Leadership and Surveillance (ATLAS) antifungal dataset through the 2024 Vivli AMR Surveillance Data Challenge to explore antifungal minimum inhibitory concentrations (MICs). The ATLAS programme through the SENTRY platform data allows for monitoring of antifungal susceptibility and resistance trending of key antifungals from across 80 countries. The antifungal data from the SENTRY platform are generated by standardized antifungal susceptibility methods performed at a central laboratory. Isolates were collected from local labs and collected specifically for surveillance. Antifungals tested were amphotericin B, anidulafungin, caspofungin, fluconazole, flucytosine, isavuconazole, itraconazole, micafungin, posaconazole, and voriconazole. Only species with ≥ 10 isolates with AFST data were included. Species of mold within a species complex were combined.
The findings and conclusions of this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control (CDC).
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| Species | Amphotericin B | Anidulafungin | Caspofungin | Fluconazole | Flucytosine | Isavuconazole | Itraconazole | Micafungin | CLSI cutoffs | Voriconazole | ECV | Isolates tested | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CLSI cutoffs | ECV | Isolates tested | CLSI cutoffs | ECV | Isolates tested | CLSI cutoffs | ECV | Isolates tested | CLSI cutoffs | ECV | Isolates tested | CLSI cutoffs | ECV | Isolates tested | CLSI cutoffs | ECV | Isolates tested | CLSI cutoffs | ECV | Isolates tested | CLSI cutoffs | ECV | Isolates tested | CLSI cutoffs | ECV | Isolates tested | ||||
| Aspergillus flavus species complex | – | 4 | 235 | – | -- | 236 | – | 0.5 | 236 | – | -- | 0 | – | -- | 54 | – | 1 | 125 | – | 1 | 235 | – | -- | 236 | – | – | 2 | 236 | 0.5 | 236 |
| Aspergillus fumigatus | – | 2 | 1669 | – | -- | 1668 | – | 0.5 | 1669 | – | -- | 0 | – | -- | 307 | – | 1 | 940 | – | 1 | 1668 | – | -- | 1669 | – | Sensitive: ≤ 0.5 |
1 | 1668 | -- | 1667 |
| Aspergillus nidulans species complex | – | -- | 53 | – | -- | 53 | – | -- | 53 | – | -- | 0 | – | -- | 8 | – | -- | 33 | – | -- | 53 | – | -- | 53 | – | – | -- | 53 | -- | 53 |
| Aspergillus niger species complex | – | 2 | 247 | – | -- | 247 | – | 0.25 | 246 | – | -- | 0 | – | -- | 48 | – | 4 | 143 | – | 4 | 245 | – | -- | 247 | – | – | 2 | 246 | 2 | 246 |
| Aspergillus terreus species complex | – | 4 | 94 | – | -- | 94 | – | 0.12 | 94 | – | -- | 0 | – | -- | 17 | – | 1 | 57 | – | 2 | 94 | – | -- | 94 | – | – | 2 | 94 | 1 | 94 |
| Aspergillus ustus species complex | – | -- | 16 | – | -- | 15 | – | -- | 12 | – | -- | 0 | – | -- | 2 | – | -- | 13 | – | -- | 14 | – | -- | 15 | – | – | -- | 16 | -- | 15 |
| Aspergillus versicolor species complex | – | 2 | 13 | – | -- | 13 | – | -- | 13 | – | -- | 0 | – | -- | 2 | – | -- | 8 | – | -- | 13 | – | -- | 13 | – | – | -- | 13 | -- | 13 |
| Candida albicans | – | 2 | 8156 | Sensitive: ≤ 0.25 |
0.12 | 8159 | Sensitive: ≤ 0.25 |
-- | 8159 | Sensitive: ≤ 2 |
0.5 | 8159 | – | -- | 2825 | – | -- | 3821 | – | -- | 6170 | Sensitive: ≤ 0.25 |
0.03 | 8159 | – | Sensitive: ≤ 0.12 |
0.03 | 8159 | 0.06 | 8159 |
| Candida auris | – | -- | 19 | – | 1 | 19 | – | 0.5 | 19 | – | -- | 19 | – | -- | 1 | – | -- | 18 | – | -- | 18 | – | 0.5 | 19 | – | – | -- | 19 | -- | 19 |
| Candida dubliniensis | – | 0.5 | 403 | – | 0.12 | 403 | – | -- | 403 | – | 0.5 | 403 | – | -- | 97 | – | -- | 228 | – | 0.25 | 304 | – | 0.12 | 403 | – | – | -- | 403 | 0.12 | 403 |
| Candida fabianii | – | -- | 23 | – | -- | 23 | – | -- | 23 | – | -- | 23 | – | -- | 7 | – | -- | 14 | – | -- | 17 | – | -- | 23 | – | – | -- | 23 | -- | 23 |
| Candida fermentati | – | -- | 40 | – | -- | 40 | – | -- | 40 | – | -- | 40 | – | -- | 15 | – | -- | 22 | – | -- | 32 | – | -- | 40 | – | – | -- | 40 | -- | 40 |
| Candida glabrata | – | 2 | 3395 | Sensitive: ≤ 0.12 |
0.25 | 3395 | Sensitive: ≤ 0.12 |
-- | 3395 | SDD: ≤ 32 |
8 | 3395 | – | -- | 1096 | – | -- | 1659 | – | 4 | 2600 | Sensitive: ≤ 0.06 |
0.03 | 3394 | – | – | 0.25 | 3395 | 1 | 3395 |
| Candida guilliermondii | – | 2 | 117 | Sensitive: ≤ 2 |
8 | 117 | Sensitive: ≤ 2 |
2 | 117 | – | 8 | 117 | – | -- | 48 | – | -- | 55 | – | 2 | 91 | Sensitive: ≤ 2 |
2 | 117 | – | – | -- | 117 | 0.5 | 117 |
| Candida haemulonii | – | -- | 15 | – | 0.5 | 15 | – | -- | 15 | – | 128 | 15 | – | -- | 3 | – | -- | 6 | – | -- | 8 | – | -- | 15 | – | – | 2 | 15 | 1 | 15 |
| Candida inconspicua | – | -- | 20 | – | -- | 20 | – | -- | 20 | – | -- | 20 | – | -- | 3 | – | -- | 9 | – | -- | 12 | – | -- | 20 | – | – | -- | 20 | -- | 20 |
| Candida kefyr | – | 2 | 146 | – | 0.25 | 146 | – | -- | 146 | – | 1 | 146 | – | -- | 36 | – | -- | 79 | – | 0.5 | 108 | – | 0.12 | 146 | – | – | -- | 146 | 0.5 | 146 |
| Candida krusei | – | 2 | 517 | Sensitive: ≤ 0.25 |
0.25 | 517 | Sensitive: ≤ 0.25 |
-- | 517 | – | -- | 152 | – | -- | 164 | – | -- | 245 | – | 1 | 380 | Sensitive: ≤ 0.25 |
0.25 | 517 | – | Sensitive: ≤ 0.5 |
0.5 | 517 | 0.5 | 517 |
| Candida lipolytica | – | -- | 15 | – | -- | 15 | – | -- | 15 | – | -- | 15 | – | -- | 6 | – | -- | 4 | – | -- | 10 | – | -- | 15 | – | – | -- | 15 | -- | 15 |
| Candida lusitaniae | – | 2 | 318 | – | 1 | 318 | – | 1 | 318 | – | 1 | 318 | – | -- | 104 | – | -- | 170 | – | 1 | 252 | – | 0.5 | 318 | – | – | -- | 318 | 0.06 | 318 |
| Candida metapsilosis | – | 1 | 57 | – | 0.5 | 57 | – | 0.25 | 57 | – | 4 | 57 | – | -- | 8 | – | -- | 40 | – | 1 | 42 | – | 1 | 57 | – | – | 0.06 | 57 | 0.25 | 57 |
| Candida nivariensis | – | -- | 10 | – | -- | 9 | – | -- | 9 | – | -- | 10 | – | -- | 2 | – | -- | 5 | – | -- | 8 | – | -- | 9 | – | – | -- | 10 | -- | 10 |
| Candida orthopsilosis | – | 2 | 129 | – | 2 | 129 | – | 1 | 129 | – | 2 | 129 | – | -- | 19 | – | -- | 76 | – | 0.5 | 86 | – | 1 | 129 | – | – | 0.12 | 129 | 0.25 | 129 |
| Candida parapsilosis | – | 1 | 2791 | Sensitive: ≤ 2 |
4 | 2792 | Sensitive: ≤ 2 |
1 | 2792 | Sensitive: ≤ 2 |
2 | 2792 | – | -- | 1025 | – | -- | 1291 | – | 0.5 | 2166 | Sensitive: ≤ 2 |
2 | 2792 | – | Sensitive: ≤ 0.12 |
-- | 2792 | 0.25 | 2792 |
| Candida pelliculosa | – | 1 | 46 | – | -- | 43 | – | -- | 43 | – | 8 | 46 | – | -- | 19 | – | -- | 16 | – | 1 | 35 | – | 0.12 | 43 | – | – | 0.25 | 46 | 2 | 46 |
| Candida tropicalis | – | 2 | 1749 | Sensitive: ≤ 0.25 |
0.12 | 1750 | Sensitive: ≤ 0.25 |
-- | 1750 | Sensitive: ≤ 2 |
1 | 1750 | – | -- | 604 | – | -- | 869 | – | 0.5 | 1383 | Sensitive: ≤ 0.25 |
0.06 | 1750 | – | Sensitive: ≤ 0.12 |
0.12 | 1750 | 0.12 | 1750 |
| Cryptococcus gattii species complex | – | 0.5 | 16 | – | -- | 16 | – | -- | 16 | – | 16 | 16 | – | 4 | 5 | – | -- | 9 | – | 0.5 | 12 | – | -- | 16 | – | – | 0.5 | 16 | -- | 15 |
| Cryptococcus neoformans | – | 0.5 | 495 | – | -- | 497 | – | -- | 497 | – | 8 | 497 | – | 8 | 218 | – | -- | 201 | – | 0.25 | 363 | – | -- | 496 | – | – | 0.25 | 497 | 0.25 | 497 |
| Exophiala dermatitidis | – | -- | 15 | – | -- | 13 | – | -- | 13 | – | -- | 0 | – | -- | 0 | – | -- | 8 | – | -- | 15 | – | -- | 12 | – | – | -- | 15 | -- | 15 |
| Fusarium oxysporum species complex | – | -- | 12 | – | -- | 12 | – | -- | 12 | – | -- | 0 | – | -- | 0 | – | -- | 10 | – | -- | 12 | – | -- | 12 | – | – | -- | 12 | -- | 12 |
| Fusarium solani species complex | – | -- | 50 | – | -- | 50 | – | -- | 50 | – | -- | 0 | – | -- | 10 | – | -- | 28 | – | -- | 50 | – | -- | 50 | – | – | -- | 50 | -- | 50 |
| Geotrichum clavatum | – | -- | 29 | – | -- | 29 | – | -- | 29 | – | -- | 29 | – | -- | 5 | – | -- | 18 | – | -- | 19 | – | -- | 29 | – | – | -- | 29 | -- | 29 |
| Gibberella fujikuroi species complex | – | -- | 31 | – | -- | 31 | – | -- | 31 | – | -- | 0 | – | -- | 11 | – | -- | 16 | – | -- | 30 | – | -- | 31 | – | – | -- | 30 | -- | 31 |
| Lomentospora prolificans | – | -- | 22 | – | -- | 22 | – | -- | 22 | – | -- | 0 | – | -- | 1 | – | -- | 16 | – | -- | 22 | – | -- | 22 | – | – | -- | 22 | -- | 22 |
| Magnusiomyces capitatus | – | -- | 18 | – | -- | 18 | – | -- | 18 | – | -- | 18 | – | -- | 5 | – | -- | 4 | – | -- | 10 | – | -- | 18 | – | – | -- | 18 | -- | 18 |
| Paecilomyces lilacinus | – | -- | 12 | – | -- | 11 | – | -- | 10 | – | -- | 0 | – | -- | 2 | – | -- | 8 | – | -- | 12 | – | -- | 12 | – | – | -- | 12 | -- | 12 |
| Paecilomyces variotii | – | -- | 11 | – | -- | 11 | – | -- | 8 | – | -- | 0 | – | -- | 2 | – | -- | 9 | – | -- | 11 | – | -- | 11 | – | – | -- | 11 | -- | 11 |
| Rasamsonia argillacea species complex | – | -- | 15 | – | -- | 15 | – | -- | 15 | – | -- | 0 | – | -- | 0 | – | -- | 11 | – | -- | 14 | – | -- | 15 | – | – | -- | 15 | -- | 14 |
| Rhizopus microsporus group | – | -- | 30 | – | -- | 29 | – | -- | 29 | – | -- | 0 | – | -- | 3 | – | -- | 18 | – | -- | 30 | – | -- | 29 | – | – | -- | 30 | -- | 30 |
| Rhizopus oryzae species complex | – | -- | 18 | – | -- | 18 | – | -- | 18 | – | -- | 0 | – | -- | 1 | – | -- | 12 | – | -- | 18 | – | -- | 18 | – | – | -- | 18 | -- | 18 |
| Rhodotorula mucilaginosa | – | 2 | 41 | – | -- | 41 | – | -- | 41 | – | -- | 40 | – | -- | 14 | – | -- | 17 | – | 4 | 29 | – | -- | 41 | – | – | 16 | 41 | 4 | 40 |
| Saccharomyces cerevisiae | – | 2 | 72 | – | 1 | 72 | – | 2 | 72 | – | 32 | 72 | – | -- | 18 | – | -- | 30 | – | 2 | 45 | – | 0.5 | 72 | – | – | 0.5 | 72 | 2 | 72 |
| Sarocladium kiliense | – | -- | 20 | – | -- | 17 | – | -- | 17 | – | -- | 0 | – | -- | 13 | – | -- | 11 | – | -- | 19 | – | -- | 17 | – | – | -- | 20 | -- | 19 |
| Scedosporium apiospermum / Scedosporium boydii | – | -- | 56 | – | -- | 56 | – | -- | 55 | – | -- | 0 | – | -- | 7 | – | -- | 32 | – | -- | 56 | – | -- | 55 | – | – | -- | 55 | -- | 56 |
| Scedosporium aurantiacum | – | -- | 13 | – | -- | 13 | – | -- | 13 | – | -- | 0 | – | -- | 1 | – | -- | 7 | – | -- | 13 | – | -- | 13 | – | – | -- | 13 | -- | 13 |
| Trichosporon asahii | – | 1 | 78 | – | -- | 78 | – | -- | 78 | – | 8 | 78 | – | -- | 29 | – | -- | 38 | – | 1 | 63 | – | -- | 78 | – | – | -- | 78 | 1 | 78 |