Fungal susceptibility testing

Area of Science:

• Medical Mycology
• Clinical Microbiology
• Antimicrobial Resistance

Background:

• The clinical utility of antifungal susceptibility testing (AFST) remains largely undetermined.
• Routine AFST is not currently recommended for most fungal infections.
• Variability in antifungal drug response necessitates careful consideration of testing.

Purpose of the Study:

• To evaluate the circumstances under which antifungal susceptibility testing is beneficial.
• To guide the appropriate application of AFST in clinical settings.
• To address the need for susceptibility data in emerging fungal diseases.

Main Methods:

• Review of current clinical guidelines and literature on AFST.
• Analysis of specific fungal pathogens where AFST has demonstrated value.
• Consideration of emerging fungal threats and the role of susceptibility data.

Main Results:

• AFST is not recommended routinely but has utility in select cases.
• Testing is valuable for certain Candida species and Pseudallescheria boydii infections.
• Susceptibility testing to azoles is particularly important for yeasts due to variable responses.

Conclusions:

• Antifungal susceptibility testing should be considered selectively, not routinely.
• Testing is crucial for novel fungal pathogens lacking clinical efficacy data.
• Targeted AFST can inform antifungal therapy choices for specific infections.