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Updated: Dec 23, 2025
Broth Microdilution In Vitro Screening: An Easy and Fast Method to Detect New Antifungal Compounds
Published on: February 14, 2018
Antifungal susceptibility testing in Candida species: current methods and promising new tools for shortening the
Ludwig Knabl1, Cornelia Lass-Flörl1
1Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck , Innsbruck, Austria.
Introduction:
Invasive fungal diseases (IFDs) have received attention as an emerging public health threat, are difficult to diagnose and to treat, and are associated with substantial morbidity and mortality. The standard of care in IFD management requires an early and targeted antifungal treatment, hence covers - amongst others - species identification and antifungal susceptibility testing (AFST).
Areas Covered:
This review gives an overview of methods currently applied in AFST and highlights promising new tools for shortening the turnaround time focusing on Candida species.
Expert Opinion:
The performance of the broth microdilution reference methods for AFST is not suitable for daily laboratory practice as they are too labor-intensive and time-consuming. Other conventional approaches such as disk diffusion assays, epsilometer tests, colorimetric or automated approaches are easier in handling, and in part, show good correlations with the reference methods. Promising results for shortening the turnaround time in providing MIC data or resistance detection include matrix-assisted laser desorption/ionization-time of flight mass spectrometer (MALDI-TOF MS) assisted AFST, molecular-based techniques and modified conventional approaches applying direct inoculation methods. These underlying AFST concepts are promising but in part completely different, have their own advantages and disadvantages, and need further clinical validation.
Insights
Antifungal susceptibility testing (AFST) is crucial for treating invasive fungal diseases (IFDs). This review explores current and novel methods for faster AFST, particularly for Candida species, to improve patient outcomes.
Area of Science:
- Medical Mycology
- Clinical Microbiology
- Antimicrobial Resistance
Background:
- Invasive fungal diseases (IFDs) pose a significant public health threat, characterized by high morbidity and mortality.
- Effective management of IFDs necessitates prompt and precise antifungal treatment, including species identification and antifungal susceptibility testing (AFST).
- Current standard AFST methods are often time-consuming and labor-intensive, hindering rapid clinical decision-making.
Purpose of the Study:
- To provide a comprehensive overview of existing antifungal susceptibility testing (AFST) methodologies.
- To highlight emerging techniques aimed at reducing the turnaround time for AFST, with a specific focus on Candida species.
Main Methods:
- Review of conventional AFST methods, including broth microdilution, disk diffusion, epsilometer tests, and automated approaches.
- Exploration of novel AFST techniques such as matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS) assisted testing, molecular-based methods, and direct inoculation techniques.
- Evaluation of the advantages and disadvantages of various AFST approaches regarding speed, accuracy, and laboratory applicability.
Main Results:
- Conventional AFST methods, while correlated with reference standards, are often unsuitable for routine diagnostics due to their lengthy procedures.
- Emerging techniques, including MALDI-TOF MS, molecular methods, and modified conventional assays, show promise for significantly shortening AFST turnaround times.
- These novel approaches offer faster detection of minimum inhibitory concentration (MIC) data and resistance mechanisms, though further clinical validation is required.
Conclusions:
- Faster AFST is critical for timely and targeted antifungal therapy in IFD management.
- Innovative methods like MALDI-TOF MS-assisted AFST and molecular techniques represent promising advancements for routine diagnostics.
- Continued research and clinical validation are essential to integrate these rapid AFST tools into standard laboratory practice for improved patient care.
