5th MMTN Conference 5-6 November 2016 Bangkok, Thailand 10:20-10:45, 6 Nov, 2016 Antifungal Resistance in Asia: Mechanisms, Epidemiology, and Consequences Yee-Chun Chen, M.D., PhD. Department of Medicine, National Taiwan University Hospital and College of Medicine; National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Taiwan Disclosure • Research grands: Pfizer, Gilead • Advisory boards: Pfizer, MSD, Gilead • Speaker: Pfizer, MSD, Gilead Contents • What is meant by resistance? • Is antifungal resistance in Candida and other yeasts a problem in Asia? • Is antifungal resistance in Aspergillus and other molds a problem in Asia? • Limitation of current published data • Conclusion What is meant by resistance? Clinical failure failure of drug therapy to resolve signs and symptoms of infection Microbiological failure of therapy to eradicate the failure organism In vitro definition based an minimum inhibitory concentrations and clinical breakpoints CLSI clinical breakpoints of antifungal resistance against Candida species C. C. C. C. C. albicans glabrata tropicalis krusei parapsilosis Anidulafungin Old ≥4 ≥4 ≥4 ≥4 ≥4 New ≥1 ≥0.5 ≥1 ≥1 ≥8 Micafungin Old ≥4 ≥4 ≥4 ≥4 ≥4 New ≥1 ≥0.25 ≥1 ≥1 ≥8 Fluconazole Old ≥64 ≥64 ≥64 ≥64 ≥64 New ≥8 ≥64 ≥8 ≥8 ≥8 Voriconazole Old ≥4 ≥4 ≥4 ≥4 ≥4 New ≥1 ≥1 * ≥1 ≥2 ≥1 *epidemiologic cutoff value Clinical and Laboratory Standards Institute (CLSI) 2008, M27-A3; 2012. M27-S4. Impact of New Antifungal Breakpoints on Antifungal Resistance in Candida Fothergill et al. J Clin Microbiol. 2014; 52:994 EUCAST Antifungal Clinical Breakpoint – Yeasts v. 8.0 valid from 2015-11-16 EUCAST Antifungal Clinical Breakpoint - Molds v. 8.0 valid from 2015-11-16 Is antifungal resistance in Candida and other yeasts a problem in Asia? Get ready for voting… pollev.com/mmtn Go to webpage: Voting question on the next slide Wifi network: MMTN2016 Password: 2016mmtn