Standardization of antifungal susceptibility testing and clinical relevance

Standardization of antifungal susceptibility testing became essential to overcome the problem of interlaboratory variability and to determine the clinical relevance of in vitro data. This evolving process began for the yeasts and consequently broth macrodilution and microdilution methods (NCCLS M27 document) have been developed. These tests may not be useful for testing all organism-drug combinations or be the most convenient techniques for routine use in the clinical laboratory. Different alternatives to the NCCLS methods are currently under investigation. The identification of standard guidelines for antifungal susceptibility testing has reduced interlaboratory variability and further progress has been achieved with the determination of tentative interpretive breakpoints for certain drug-yeast combinations. However, these breakpoints are not adequate for interpretations of MICs for fungi-drug combinations beyond the setting for which they were determined. The NCCLS Subcommittee has also generated data for proposed testing guidelines for the moulds.