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Antifungal susceptibility testing: technical advances and potential clinical applications
M A Pfaller1, J H Rex, M G Rinaldi
1Department of Pathology, University of Iowa College of Medicine, Iowa City 52242, USA.
Summary
Standardized antifungal susceptibility testing methods are now available, improving reproducibility and clinical relevance. This enables better treatment of fungal infections, especially in immunocompromised patients.
Area of Science:
- Medical Microbiology
- Clinical Laboratory Science
Background:
- Clinical application of antifungal susceptibility testing is hindered by poor reproducibility and uncertain clinical relevance.
- Standardized methods are crucial for reliable antifungal susceptibility testing.
Purpose of the Study:
- To review the development and application of standardized antifungal susceptibility testing methods.
- To provide recommendations for clinical laboratory practices.
Main Methods:
- Evaluation of standardized methods like NCCLS M27-T.
- Assessment of user-friendly methods including microdilution broth and stable gradient technology.
- Exploration of disk diffusion methods and adaptation for filamentous fungi.
Main Results:
- Standardized methods enhance reproducibility and clinical relevance of antifungal susceptibility testing.
- Emerging correlations between Minimum Inhibitory Concentrations (MICs) and clinical response, particularly for fluconazole and itraconazole in HIV-associated oropharyngeal candidiasis.
- Promising adaptation of standard methods for filamentous fungi.
Conclusions:
- Standardized antifungal susceptibility testing is essential for effective management of fungal infections.
- Clinical laboratories can now implement reliable antifungal susceptibility testing based on accumulated experience and emerging data.
- Further application to new antifungal agents and diseases will improve antifungal therapy.