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Review
. 2020 Apr 29;33(3):e00069-19.
doi: 10.1128/CMR.00069-19. Print 2020 Jun 17.

Antifungal Susceptibility Testing: Current Approaches

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Review

Antifungal Susceptibility Testing: Current Approaches

Elizabeth L Berkow et al. Clin Microbiol Rev. .

Abstract

Although not as ubiquitous as antibacterial susceptibility testing, antifungal susceptibility testing (AFST) is a tool of increasing importance in clinical microbiology laboratories. The goal of AFST is to reliably produce MIC values that may be used to guide patient therapy, inform epidemiological studies, and track rates of antifungal drug resistance. There are three methods that have been standardized by standards development organizations: broth dilution, disk diffusion, and azole agar screening for Aspergillus Other commonly used methods include gradient diffusion and the use of rapid automated instruments. Novel methodologies for susceptibility testing are in development. It is important for laboratories to consider not only the method of testing but also the interpretation (or lack thereof) of in vitro data.

Keywords: CLSI; EUCAST; antifungal resistance; antifungal susceptibility testing; breakpoints; epidemiological cutoff value.

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Figures

FIG 1
FIG 1
Fluconazole gradient diffusion strips distinguish between isolates that are fluconazole susceptible (A), fluconazole resistant (B), or fluconazole susceptible but displaying heavy “trailing” growth (C).
FIG 2
FIG 2
Example of paradoxical growth phenomenon. There is complete clearing of the wells after the MIC point for anidulafungin, but there is a distinct drop-off in growth and then a distinct regrowth further up the concentration gradient for caspofungin, as indicated with an asterisk.

References

    1. Rex JH, Pfaller MA, Galgiani JN, Bartlett MS, Espinel-Ingroff A, Ghannoum MA, Lancaster M, Odds FC, Rinaldi MG, Walsh TJ, Barry AL. 1997. Development of interpretive breakpoints for antifungal susceptibility testing: conceptual framework and analysis of in vitro-in vivo correlation data for fluconazole, itraconazole, and candida infections. Subcommittee on Antifungal Susceptibility Testing of the National Committee for Clinical Laboratory Standards. Clin Infect Dis 24:235–247. doi:10.1093/clinids/24.2.235. - DOI - PubMed
    1. Calhoun DL, Roberts GD, Galgiani JN, Bennett JE, Feingold DS, Jorgensen J, Kobayashi GS, Shadomy S. 1986. Results of a survey of antifungal susceptibility tests in the United States and interlaboratory comparison of broth dilution testing of flucytosine and amphotericin B. J Clin Microbiol 23:298–301. doi:10.1128/JCM.23.2.298-301.1986. - DOI - PMC - PubMed
    1. Galgiani JN, Reiser J, Brass C, Espinel-Ingroff A, Gordon MA, Kerkering TM. 1987. Comparison of relative susceptibilities of Candida species to three antifungal agents as determined by unstandardized methods. Antimicrob Agents Chemother 31:1343–1347. doi:10.1128/aac.31.9.1343. - DOI - PMC - PubMed
    1. National Committee for Clinical Laboratory Standards. 1997. Reference method for broth dilution antifungal susceptibility testing of yeasts. National Committee for Clinical Laboratory Standards, Wayne, PA.
    1. . 2008. EUCAST definitive document EDef 7.1: method for the determination of broth dilution MICs of antifungal agents for fermentative yeasts. Clin Microbiol Infect 14:398–405. doi:10.1111/j.1469-0691.2007.01935.x. - DOI - PubMed

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