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Antifungal Susceptibility

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Michael A. Pfaller – 1st expert on this subject based on the ideXlab platform

  • Utility of Antifungal Susceptibility Testing and Clinical Correlations
    Interactions of Yeasts Moulds and Antifungal Agents, 2011
    Co-Authors: Daniel J. Diekema, Michael A. Pfaller


    In this chapter, we review the available published data addressing the clinical relevance of Antifungal Susceptibility test results. By far the most data exist to support the clinical relevance of AFST results for Candida against fluconazole, and these data suggest that the clinical utility of this information mirrors that put forward for antibacterial Susceptibility testing. Clinical relevance has also been demonstrated for selected other Antifungal agents against Candida and Cryptococcus spp. By contrast, little direct support for the clinical utility of AFST for moulds is available.

  • Antifungal Susceptibility testing methods.
    Current Drug Targets, 2005
    Co-Authors: Michael A. Pfaller


    : The number of systemically active Antifungal agents has increased dramatically in recent years in response to the challenge of invasive mycoses. Additional work is needed to better understand the mechanisms of action of these agents as well as the mechanisms of resistance expressed by the fungal pathogens. Antifungal Susceptibility testing has been standardized and refined and now may be considered to play an important role in the management of invasive mycoses. More work is needed to optimize the methods for testing new Antifungal agents and for testing pathogens other than Candida. The ongoing efforts and international collaborations designed to address these issues will provide important information that will improve the management of serious fungal infections.

  • has Antifungal Susceptibility testing come of age
    Clinical Infectious Diseases, 2002
    Co-Authors: Michael A. Pfaller


    : The in vitro Susceptibility of an infecting organism to the antimicrobial agent selected for therapy is one of several factors that influence the likelihood that therapy for an infection will be successful. To appreciate the value of Antifungal Susceptibility testing, it is helpful to review the overall predictive utility of antibacterial Susceptibility testing. After >30 years of study, in vitro Susceptibility can be said to predict the response of bacterial infections with an accuracy that is well summarized as the “90-60 rule”: infections due to susceptible isolates respond to therapy approximately 90% of the time, whereas infections due to resistant isolates respond approximately 60% of the time. On the basis of a growing body of knowledge, standardized Susceptibility testing for selected organism-drug combinations (most notably, Candida species and the azole Antifungal agents) has been shown to have similar predictive utility. Antifungal Susceptibility testing is now increasingly and appropriately used as a routine adjunct to the treatment of fungal infections.

Jacques F. Meis – 2nd expert on this subject based on the ideXlab platform

  • Antifungal Susceptibility Testing of Fusarium: A Practical Approach.
    Journal of Fungi, 2017
    Co-Authors: Abdullah M. S. Al-hatmi, Jacques F. Meis, Ilse Curfs-breuker, G. Sybren De Hoog, Paul E. Verweij


    In vitro Susceptibility testing of Fusarium is becoming increasingly important because of frequency and diversity of infections and because resistance profiles are species-specific. Reference methods for Antifungal Susceptibility testing (AFST) are those of Clinical and Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility (EUCAST), but breakpoints (BPs) have not yet been established. One of the problems is that phylogenetic distances between Fusarium species are much smaller than between species of, e.g., Candida. Epidemiological cutoff values (ECVs) for some Fusarium species have been determined in order to differentiate wild-type from non-wild-type isolates. In clinical routine, commercially available assays such as Etest, Sensititre or others provide essential agreement with reference methods. Our objective is to summarize Antifungal Susceptibility testing of Fusarium genus in the clinical laboratory: how to do it, when to do it, and how to interpret it.

  • Molecular epidemiology and Antifungal Susceptibility of Serbian Cryptococcus neoformans isolates
    Mycoses, 2014
    Co-Authors: Valentina Arsic Arsenijevic, Marina Pekmezovic, Jacques F. Meis, Ferry Hagen


    Molecular typing and Antifungal Susceptibility testing of 34 clinical Serbian Cryptococcus neoformans isolates from 25 patients was retrospectively performed. Amplified fragment length polymorphism (AFLP) fingerprinting was used for genotyping, whereas a novel real-time PCR was used to determine the mating- and serotype. The Antifungals amphotericin B, 5-fluorocytosine, fluconazole, voriconazole, itraconazole and posaconazole were used to determine the Antifungal Susceptibility profiles. The majority of isolates belonged to genotype AFLP1/VNI (n = 20; 58.8%), followed by AFLP2/VNIV (n = 10; 29.4%), AFLP3/VNIII (n = 3; 8.8%) and AFLP1B/VNII (n = 1; 2.9%). All AFLP1/VNI isolates were mating-serotype alphaA, the sole AFLP1B/VNII isolate was found to be aA, whereas AFLP2/VNIV harboured serotype D isolates with either the a (n = 2; 5.9%) or alpha (n = 8; 23.5%) mating-type allele. The isolates (n = 3; 8.8%) that were found to be genotype AFLP3/VNIII had the hybrid mating- and serotype combination aA-alphaD. In vitro Antifungal Susceptibility testing showed that all isolates were susceptible to amphotericin B, voriconazole and posaconazole. Low resistance level was observed for fluconazole (n = 1; 2.9%) and 5-fluorocytosine. (n = 2; 5.8%). A large percentage of isolates was found to be susceptible dose dependent to itraconazole (n = 16; 47.1%). AFLP1/VNI was the most common genotype among clinical C. neoformans isolates from immunocompromised patients in Serbia. C. neoformans from HIV-negative patients were significantly less susceptible to 5-fluorocytosine (P < 0.01). Correlation between genotypes and Antifungal Susceptibility was not observed.

  • taxonomy and Antifungal Susceptibility of clinically important rasamsonia species
    Journal of Clinical Microbiology, 2013
    Co-Authors: Jos Houbraken, Jacques F. Meis, Sandrine Giraud, M Meijer, Sebastien Bertout, Jens Christian Frisvad, Jeanphilippe Bouchara, R A Samson


    In recent years, Geosmithia argillacea has been increasingly reported in humans and animals and can be considered an emerging pathogen. The taxonomy of Geosmithia was recently studied, and Geosmithia argillacea and related species were transferred to the new genus Rasamsonia. The diversity among a set of Rasamsonia argillacea strains, including 28 clinical strains, was studied, and Antifungal Susceptibility profiles were generated. Data obtained from morphological studies and from phylogenetic analyses of internal transcribed spacer (ITS) and partial β-tubulin and calmodulin sequences revealed the presence of four species in the Rasamsonia argillacea complex, two of which are newly described here: R. piperina sp. nov. and R. aegroticola sp. nov. In contrast to other related genera, all Rasamsonia species can be identified with ITS sequences. A retrospective identification was performed on recently reported clinical isolates from animal or human patients. Susceptibility tests showed that the Antifungal Susceptibility profiles of the four members of the R. argillacea complex are similar, and caspofungin showed significant activity in vitro, followed by amphotericin B and posaconazole. Voriconazole was the least active of the Antifungals tested. The phenotypically similar species R. brevistipitata and R. cylindrospora had different Antifungal Susceptibility profiles, and this indicates that correct species identification is important to help guide appropriate Antifungal therapy.

Michael G. Rinaldi – 3rd expert on this subject based on the ideXlab platform

  • Antifungal Susceptibility testing of exophiala spp a head to head comparison of amphotericin b itraconazole posaconazole and voriconazole
    Medical Mycology, 2009
    Co-Authors: Annette W. Fothergill, Michael G. Rinaldi, Deanna A. Sutton


    Frequently, diseases caused by black yeasts are chronic in nature with a high morbidity. In addition, these infections are often fatal and relapse is common, even after prolonged treatment. Although the CLSI Document M38-A outlines methods for Antifungal Susceptibility testing of moulds, Exophiala spp. are not directly discussed. In an effort to determine the Antifungal Susceptibility patterns of Exophiala spp. we tested 160 clinical isolates against amphotericin B, itraconazole, posaconazole, and voriconazole in a head-to-head comparison. Posaconazole and itraconazole were the most active in vitro with MICs falling well below the achievable serum levels typically observed with standard dosing regimens.

  • Antifungal Susceptibility testing.
    Infectious Disease Clinics of North America, 2006
    Co-Authors: Annette W. Fothergill, Michael G. Rinaldi, Deanna A. Sutton


    : Antifungal Susceptibility testing has been in routine use now for more than 15 years and has become a useful tool for clinicians who are faced with difficult treatment decision. Although most clinicians order Susceptibility testing, much confusion still exists regarding the use of the results. Sufficient data have been generated to determine Susceptibility trends for specific fungi against specific agents, but correlation data are minimal. Despite the lack of correlation data, Antifungal Susceptibility testing continues to provide useful information to assist with patient care.

  • Antifungal Susceptibility testing technical advances and potential clinical applications
    Clinical Infectious Diseases, 1997
    Co-Authors: Michael A. Pfaller, Michael G. Rinaldi


    : The clinical application of in vitro Antifungal Susceptibility testing has been limited by a lack of reproducibility and uncertain clinical relevance. As a result of several collaborative studies, the National Committee for Clinical Laboratory Standards (NCCLS) has proposed a standardized Antifungal Susceptibility test method, NCCLS M27-T. More convenient, user-friendly methods (microdilution broth and stable gradient technology) have been evaluated, and the potential for a similar process with a disk diffusion method is apparent. Adaptation of the standard method for Susceptibility testing of filamentous fungi appears promising. The existence of a standardized method facilitates meaningful analysis of studies addressing the issue of clinical relevance of Antifungal Susceptibility testing. Correlation of MICs with clinical response to therapy is beginning to emerge, most notably in relation to fluconazole and itraconazole therapy for oropharyngeal candidiasis associated with infection with the human immunodeficiency virus. This accumulated experience with Antifungal Susceptibility testing allows us to provide several specific recommendations for Antifungal Susceptibility testing in the clinical laboratory. Application of this developing technology to new Antifungal agents and other disease states will enhance our ability to effectively deal with the emerging problem of fungal infection.