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In vitro antifungal susceptibility methods and clinical implications of antifungal resistance
A Espinel-Ingroff1, D W Warnock, J A Vazquez
1Medical College of Virginia Commonwealth University, Richmond 23298-0049, USA. avingrof@hsc.vcu.edu
Abstract:
As new antifungal agents are introduced for the treatment of infections caused by yeasts and filamentous fungi (moulds), it is important that reliable methods are available for the in vitro testing of both new and established agents. The ultimate goal of in vitro testing is the prediction of the clinical outcome of therapy. The use of the M27-A procedures that were developed by the US National Committee for Clinical Laboratory Standards (NCCLS) has led to increased interlaboratory agreement of minimum inhibitory concentrations (MICs) for yeasts and has facilitated the establishment of interpretive breakpoints for fluconazole and itraconazole. The clinical relevance and limitations of these breakpoints are discussed elsewhere. The focus of this paper is to review the advantages and disadvantages of the available methods for antifungal susceptibility testing of yeasts and moulds as well as the clinical implications of in vitro antifungal resistance.
Insights
Reliable antifungal susceptibility testing is crucial for predicting treatment success. Standardized methods improve accuracy in determining minimum inhibitory concentrations (MICs) for yeasts and moulds.
Area of Science:
- Medical Mycology
- Clinical Microbiology
- Antimicrobial Resistance
Background:
- Emerging antifungal agents necessitate validated in vitro testing methods.
- Accurate susceptibility testing is key to predicting clinical outcomes for fungal infections.
- Standardized procedures enhance interlaboratory agreement for minimum inhibitory concentrations (MICs).
Purpose of the Study:
- To review available methods for antifungal susceptibility testing in yeasts and moulds.
- To discuss the advantages and disadvantages of current antifungal testing methodologies.
- To explore the clinical implications of in vitro antifungal resistance.
Main Methods:
- Evaluation of standardized procedures, such as NCCLS M27-A.
- Comparative analysis of different in vitro antifungal susceptibility testing methods.
- Review of established interpretive breakpoints for antifungal agents.
Main Results:
- Standardized methods have improved interlaboratory agreement for yeast MICs.
- Established breakpoints for fluconazole and itraconazole facilitate clinical interpretation.
- The study highlights the need for reliable methods for both yeasts and moulds.
Conclusions:
- Validated in vitro antifungal susceptibility testing is essential for guiding therapy.
- Understanding the limitations of current methods and breakpoints is critical.
- Addressing in vitro antifungal resistance is vital for effective treatment of fungal infections.