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Antifungal Susceptibility Testing of Fusarium: A Practical Approach

Abdullah M S Al-Hatmi1,2,3, Ilse Curfs-Breuker4, G Sybren de Hoog5,6,7

  • 1Westerdijk Fungal Biodiversity Institute, PO Box 85167, 3508 AD Utrecht, The Netherlands. abdullaalhatmi@gmail.com.

Journal of Fungi (Basel, Switzerland)
|January 27, 2018
PubMed

Insights

Antifungal susceptibility testing (AFST) for Fusarium is crucial due to rising infections and species-specific resistance. This summary guides clinical labs on performing, timing, and interpreting AFST for Fusarium, aiding treatment decisions.

Area of Science:

  • Medical Mycology
  • Clinical Microbiology
  • Antimicrobial Resistance

Background:

  • Increasing frequency and diversity of *Fusarium* infections necessitate reliable in vitro susceptibility testing.
  • Species-specific resistance profiles in *Fusarium* complicate treatment strategies.
  • Established reference methods (CLSI, EUCAST) lack species-specific breakpoints for *Fusarium*.

Purpose of the Study:

  • To summarize antifungal susceptibility testing (AFST) for the *Fusarium* genus in clinical laboratory settings.
  • To provide guidance on the 'how-to,' 'when-to,' and 'how-to-interpret' aspects of *Fusarium* AFST.
  • To address the challenges posed by small phylogenetic distances between *Fusarium* species.

Main Methods:

  • Review of established reference methods (CLSI, EUCAST) for antifungal susceptibility testing.
  • Discussion of epidemiological cutoff values (ECVs) for differentiating wild-type from non-wild-type *Fusarium* isolates.
  • Evaluation of commercially available assays (e.g., Etest, Sensititre) for their agreement with reference methods.

Main Results:

  • While reference methods exist, breakpoints for *Fusarium* are not yet established.
  • Epidemiological cutoff values (ECVs) have been determined for some *Fusarium* species.
  • Commercial assays demonstrate essential agreement with reference methods in clinical routine.

Conclusions:

  • Standardized AFST for *Fusarium* is essential for effective clinical management.
  • Further research is needed to establish definitive breakpoints for *Fusarium* species.
  • Clinical laboratories can utilize available methods and ECVs for guiding *Fusarium* antifungal therapy.
Keywords:
CLSIEUCASTEtestFusariumclinical laboratorysusceptibility test

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