Optimizing Echinocandin dosing and susceptibility breakpoint determination via in vivo pharmacodynamic evaluation against Candida glabrata with and without fks mutations

Antimicrob Agents Chemother. 2012 Nov;56(11):5875-82. doi: 10.1128/AAC.01102-12. Epub 2012 Sep 4.

Abstract

Echinocandins are a preferred therapy for invasive candidiasis due to their potency and broad spectrum. Resistance, especially in Candida glabrata, is an emerging threat to their use. Pharmacodynamic (PD) studies examining reduced susceptibility secondary to fks mutations in C. glabrata are lacking. The current study explored PD targets for anidulafungin, caspofungin, and micafungin in an in vivo invasive candidiasis model against 11 C. glabrata isolates with known or putative fks mutations. The PD targets were compared to those of 8 wild-type (WT) isolates. The MIC ranges in the WT group were 0.03 to 0.25 mg/liter for anidulafungin, 0.03 to 0.25 mg/liter for caspofungin, and 0.01 to 0.06 mg/liter for micafungin. The MIC ranges for mutants were 0.06 to 4, 0.25 to 16, and 0.13 to 8 mg/liter for the same compounds, respectively. The mean free drug 24-h area under the concentration-time curve (AUCf)/MIC ratio associated with a stasis endpoint for the WT group was 13.2 for anidulafungin, 2.04 for caspofungin, and 6.78 for micafungin. Comparative values for mutants were 3.43, 2.67, and 0.90, respectively. Pharmacokinetic data from patients suggest that the C. glabrata PD targets needed for success in this model could be achieved based on MIC values of 0.25 mg/liter for anidulafungin, 2 mg/liter for caspofungin, and 0.5 mg/liter for micafungin. These values are higher than recently identified epidemiology cutoff values (ECVs). The results suggest that drug-specific MIC breakpoints could be increased for caspofungin and micafungin against C. glabrata and could include organisms with mutations in fks-1 and fks-2. While identification of genetic mutants is epidemiologically important, the phenotype (MIC) provides a better predictor of therapeutic efficacy.

MeSH terms

  • Anidulafungin
  • Animals
  • Antifungal Agents / pharmacokinetics
  • Antifungal Agents / pharmacology*
  • Area Under Curve
  • Candida glabrata / drug effects*
  • Candida glabrata / genetics
  • Candida glabrata / growth & development
  • Candidiasis, Invasive / drug therapy*
  • Candidiasis, Invasive / microbiology
  • Caspofungin
  • Echinocandins / pharmacokinetics
  • Echinocandins / pharmacology*
  • Female
  • Fungal Proteins / genetics
  • Fungal Proteins / metabolism*
  • Glucosyltransferases / genetics
  • Glucosyltransferases / metabolism*
  • Humans
  • Kidney / drug effects
  • Kidney / microbiology
  • Lipopeptides / pharmacokinetics
  • Lipopeptides / pharmacology*
  • Male
  • Micafungin
  • Mice
  • Mice, Inbred ICR
  • Microbial Sensitivity Tests
  • Mutation

Substances

  • Antifungal Agents
  • Echinocandins
  • Fungal Proteins
  • Lipopeptides
  • Anidulafungin
  • Glucosyltransferases
  • Caspofungin
  • Micafungin