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Chapter 8.10 : Antifungal Susceptibility Testing

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Antifungal Susceptibility Testing, Page 1 of 2

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Abstract:

Until recently, antifungal susceptibility testing (AFST) has lagged behind its antibacterial counterpart. A number of important achievements helped propel the antifungal susceptibility field. These achievements include publication of the approved reference method for broth dilution AFST of yeast, document M27-A3 of the Clinical and Laboratory Standards Institute (CLSI; formerly National Committee for Clinical Laboratory Standards [NCCLS]) ( ); publication of interpretive breakpoints using this method ( ); the recommended use of AFST during selection of therapy of patients with candidemia and hematogenously disseminated candidiasis as outlined by the published guidelines for the treatment of candidiasis ( ); publication of a reference method for broth dilution AFST of conidium-forming filamentous fungi, CLSI document M38-A2 ( ); and recent development and publication of AFST methods for dermatophytes ( ). The procedures described below are based on CLSI documents M27-A3, M27-S3, and M38-A2.

Citation: Garcia L. 2010. Antifungal Susceptibility Testing, p 515-515. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch8.10
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References

/content/book/10.1128/9781555817435.chap8.10
1.Clinical and Laboratory Standards Institute. 2008. Reference Method for Broth Dilution Antifungal Susceptibility Testing of Yeasts, 3rd ed. Approved standard M27-A3. Clinical and Laboratory Standards Institute, Wayne, PA.
2.Clinical and Laboratory Standards Institute. 2008. Reference Method for Broth Dilution Antifungal Susceptibility Testing of Yeasts, 3rd ed. Informational supplement M27-S3. Clinical and Laboratory Standards Institute, Wayne, PA.
3.Clinical and Laboratory Standard Institute. 2008. Reference Method for Broth Dilution Antifungal Susceptibility Testing of Filamentous Fungi. Approved standard M38-A2. Clinical and Laboratory Standards Institute, Wayne, PA.
4. Ghannoum, M. A.,, A. S. Ibrahim,, Y. Fu,, M. C. Shafiq,, J. E. Edwards, Jr., and R. S. Criddle. 1992. Susceptibility testing of Cryptococcus neoformans: a microdilution technique. J. Clin. Microbiol. 30:28812886.
5. Jessup, C. J.,, J. Warner,, N. Isham,, I. Hasan,, and M. A. Ghannoum. 2000. Antifungal sus-ceptibility testing of dermatophytes: establishing a medium for inducing conidial growth and evaluation of susceptibility of clinical isolates. J. Clin. Microbiol. 38:341344.
6. Pappas, P. G.,, J. H. Rex,, J. D. Sobel,, S. G. Filler,, W. E. Dismukes,, T. J. Walsh,, and J. E. Edwards. 2004. Guidelines for treatment of candidiasis. Clin. Infect. Dis. 38:161189.
7. Pfaller, M. A.,, L. Boyken,, R. J. Hollis,, J. Kroeger,, S. A. Messer,, S. Tendolkar,, and D. J. Diekema. 2008. In vitro susceptibility of invasive isolates of Candida spp. to anidula-fungin, caspofungin, and micafungin: six years of global surveillance. J. Clin. Microbiol. 46:150156.
8. Pfaller, M. A.,, D. J. Diekema,, L. Ostrosky-Zeichner,, J. H. Rex,, B. D. Alexander,, D. Andes,, S. D. Brown,, V. Chaturvedi,, M. A. Ghannoum,, C. C. Knapp,, D. J. Sheehan,, and T. J. Walsh. 2008. Correlation of MIC with outcome for Candida species tested against caspofungin, anidulafungin, and mi-cafungin: analysis and proposal for interpretive MIC breakpoints. J. Clin. Microbiol. 46:26202629.
9. Pfaller, M. A.,, D. J. Diekema,, J. H. Rex,, A. Espinel-Ingroff,, E. M. Johnson,, D. Andes,, V. Chaturvedi,, M. A. Ghannoum,, F. C. Odds,, M. G. Rinaldi,, D. J. Sheehan,, P. Troke,, T. J. Walsh,, and D. W. Warnock. 2006. Correlation of MIC with outcome for Candida species tested against voriconazole: analysis and proposal for interpretive break-points. J. Clin. Microbiol. 44:819826.
10. Rex, J. H.,, M. A. Pfaller,, J. N. Galgiani,, M. S. Bartlett,, A. Espinel-Ingroff,, M. A. Ghannoum,, M. Lancaster,, F. C. Odds,, M. G. Rinaldi,, T. J. Walsh,, and A. L. Barry. 1997. Development of interpretive breakpoints for antifungal susceptibility testing: conceptual framework and analysis of in vitro-in vivo correlation data for fluconazole, itraconazole, and Candida infections. Subcommittee on Anti-fungal Susceptibility Testing of the National Committee for Clinical Laboratory Standards. Clin. Infect. Dis. 24:235247.
1.Clinical and Laboratory Standards Institute. 2004. Method for Antifungal Disk DiffusionSusceptibility Testing of Yeasts. Approved standard M44-A. Clinical and Laboratory Standards Institute, Wayne, PA.
2.Clinical and Laboratory Standards Institute. 2007. Zone Diameter Interpretive Standards, Corresponding Minimal Inhibitory Concentration (MIC) Interpretive Breakpoints and Quality Control Limits for Antifungal Disk Diffusion Susceptibility Testing of Yeasts, 2nd ed. Informational supplement M44-S2. Clinical and Laboratory Standards Institute, Wayne, PA.

Tables

Generic image for table
Table 8.10.1-1

Dilution procedure for water-soluble drugs

Citation: Garcia L. 2010. Antifungal Susceptibility Testing, p 515-515. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch8.10
Generic image for table
Table 8.10.1-2

Dilution procedure for water-insoluble drugs

Citation: Garcia L. 2010. Antifungal Susceptibility Testing, p 515-515. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch8.10
Generic image for table
Table 8.10.1-3

Recommended 24-h MIC limits for two QC strains for broth microdilution

Citation: Garcia L. 2010. Antifungal Susceptibility Testing, p 515-515. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch8.10
Generic image for table
Table 8.10.1-4

Dilution procedure for water-insoluble drugs used in broth microdilution susceptibility tests for nondermatophyte isolates.

2× concentration.

Citation: Garcia L. 2010. Antifungal Susceptibility Testing, p 515-515. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch8.10
Generic image for table
Table 8.10.1-5

Dilution procedure for water-insoluble drugs used in broth dilution susceptibility tests for dermatophyte isolates

2× concentrations.

Citation: Garcia L. 2010. Antifungal Susceptibility Testing, p 515-515. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch8.10
Generic image for table
Table 8.10.1-6

Dilution procedure for water-soluble drugs

Citation: Garcia L. 2010. Antifungal Susceptibility Testing, p 515-515. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch8.10
Generic image for table
Table 8.10.1-7

Interpretive breakpoints for Candida spp.

Citation: Garcia L. 2010. Antifungal Susceptibility Testing, p 515-515. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch8.10
Generic image for table
Table 8.10.2-1

Disk diffusion zone diameter breakpoint ranges for QC isolates

NA, not applicable.

Citation: Garcia L. 2010. Antifungal Susceptibility Testing, p 515-515. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch8.10
Generic image for table
Table 8.10.2-2

Zone diameter interpretive standards and corresponding MIC breakpoints for spp.

S, susceptible; R, resistant; S-DD, susceptible—dose dependent; R, resistant.

Citation: Garcia L. 2010. Antifungal Susceptibility Testing, p 515-515. In Clinical Microbiology Procedures Handbook, 3rd Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817435.ch8.10

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