Commercial Methods for Antifungal Susceptibility Testing of Yeasts: Strengths and Limitations as Predictors of Resistance

Susceptibility testing can yield variable results because it is method (commercial or reference), agent, and species dependent. Therefore, in order for results to be clinically relevant, MICs (minimal inhibitory concentrations) or MECs (minimal effective concentrations) should help in selecting the...

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Bibliographic Details
Published in:Journal of fungi (Basel) 2022-03, Vol.8 (3), p.309
Main Author: Espinel-Ingroff, Ana
Format: Article
Language:English
Subjects:
Agreements
Amino acids
antifungal resistance
Breakpoints
Candida and triazole mutants
Clinical trials
echinocandin mutants
ECVs for commercial methods
Enzymes
Epidemiology
Etest and SYO ECVs for Candida spp
Fluconazole
Genes
Laboratories
Literature reviews
Methods
Micafungin
Mutation
Posaconazole
Review
Species
Susceptibility
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Summary:Susceptibility testing can yield variable results because it is method (commercial or reference), agent, and species dependent. Therefore, in order for results to be clinically relevant, MICs (minimal inhibitory concentrations) or MECs (minimal effective concentrations) should help in selecting the best treatment agent in the clinical setting. This is accomplished by categorical endpoints, ideally, breakpoints (BPs) and/or ECVs/ECOFFs (epidemiological cutoff values). BPs and ECVs are available by the reference methods (CLSI [Clinical and Laboratory Standards Institute] and EUCAST [European Committee on Antifungal Susceptibility Testing]) for a variety of species/agent combinations. The lack of clinical data precludes establishment of BPs for susceptibility testing by the commercial methods and ECVs have only been calculated for the Etest and SYO assays. The goal of this review is to summarize the variety of commercial methods for antifungal susceptibility testing and the potential value of Etest and SYO ECVs for detecting mutants/non-wild type (NWT) isolates. Therefore, the literature search focused on publications where the commercial method, meaning MICs and ECVs, were reported for specific NWT isolates; genetic mutations have also been listed. For the Etest, the best performers recognizing the NWT were anidulafungin ECVs: 92% for the common species; 97% for and fluconazole ECVs, mostly for (45 NWT isolates). By the SYO, posaconazole ECVs recognized 93% of the and 96% of the NWT isolates and micafungin ECVs 94% (mostly and ). Smaller sets, some with clinical data, were also listed. These are promising results for the use of both commercial methods to identify antifungal resistance (NWT isolates). However, ECVs for other species and methods need to be defined, including the complex and emerging species.
ISSN:2309-608X
2309-608X
DOI:10.3390/jof8030309