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Utility of mould susceptibility testing.
1Medical College of Virginia Commonwealth, Richmond, Virginia 23298-0049, USA. avingrof@hsc.vcu.edu
Current Opinion in Infectious Diseases
|November 19, 2003
Summary
Accurate antifungal susceptibility testing for moulds is crucial for guiding treatment. While methods have improved, more in-vitro versus in-vivo data are needed to predict clinical outcomes for mould infections.
Area of Science:
- Medical Mycology
- Clinical Microbiology
- Antifungal Drug Development
Background:
- New antifungal agents like caspofungin and voriconazole are available for mould infections.
- Reports of mould resistance highlight the importance of laboratory testing.
- Antifungal susceptibility testing (AFST) methods for moulds have evolved.
Purpose of the Study:
- To review available AFST methods for moulds.
- To assess data on clinical implications of mould AFST since 2002.
- To discuss the role of laboratory testing in managing mould infections.
Main Methods:
- Review of published literature on mould AFST.
- Analysis of guidelines from the National Committee for Clinical Laboratory Standards (NCCLS).
- Examination of studies on new antifungal agents and resistance mechanisms.
Main Results:
- NCCLS M38-A document provides standardized methods for mould AFST.
- Limited in-vitro/in-vivo correlation data exist for moulds.
- Interlaboratory agreement on minimum inhibitory concentrations (MICs) has improved for yeasts, enabling breakpoints.
Conclusions:
- Predicting clinical outcomes of antifungal therapy remains the goal of AFST.
- Breakpoints for antifungals against mould species are not yet established.
- Further research correlating in-vitro results with in-vivo outcomes in moulds is essential.