Role and Interpretation of Antifungal Susceptibility Testing for the Management of Invasive Fungal Infections
Invasive fungal infections (IFIs) are associated with high mortality rates and timely appropriate antifungal therapy is essential for good outcomes. Emerging antifungal resistance among <i>Candida</i> and <i>Aspergillus</i> spp., the major causes of IFI, is concerning and has...
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2020-12-01
|
| Series: | Journal of Fungi |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2309-608X/7/1/17 |
| _version_ | 1797543052454133760 |
|---|---|
| author | Frederic Lamoth Russell E. Lewis Dimitrios P. Kontoyiannis |
| author_facet | Frederic Lamoth Russell E. Lewis Dimitrios P. Kontoyiannis |
| author_sort | Frederic Lamoth |
| collection | DOAJ |
| description | Invasive fungal infections (IFIs) are associated with high mortality rates and timely appropriate antifungal therapy is essential for good outcomes. Emerging antifungal resistance among <i>Candida</i> and <i>Aspergillus</i> spp., the major causes of IFI, is concerning and has led to the increasing incorporation of in vitro antifungal susceptibility testing (AST) to guide clinical decisions. However, the interpretation of AST results and their contribution to management of IFIs remains a matter of debate. Specifically, the utility of AST is limited by the delay in obtaining results and the lack of pharmacodynamic correlation between minimal inhibitory concentration (MIC) values and clinical outcome, particularly for molds. Clinical breakpoints for <i>Candida</i> spp. have been substantially revised over time and appear to be reliable for the detection of azole and echinocandin resistance and for outcome prediction, especially for non-neutropenic patients with candidemia. However, data are lacking for neutropenic patients with invasive candidiasis and some non-<i>albicans Candida</i> spp. (notably emerging <i>Candida auris</i>). For <i>Aspergillus</i> spp., AST is not routinely performed, but may be indicated according to the epidemiological context in the setting of emerging azole resistance among <i>A. fumigatus</i>. For non-<i>Aspergillus</i> molds (e.g., <i>Mucorales</i>, <i>Fusarium</i> or <i>Scedosporium</i> spp.), AST is not routinely recommended as interpretive criteria are lacking and many confounders, mainly host factors, seem to play a predominant role in responses to antifungal therapy. This review provides an overview of the pre-clinical and clinical pharmacodynamic data, which constitute the rationale for the use and interpretation of AST testing of yeasts and molds in clinical practice. |
| first_indexed | 2024-03-10T13:40:12Z |
| format | Article |
| id | doaj.art-e822c0ff0e7944de91c93d8ae938e708 |
| institution | Directory Open Access Journal |
| issn | 2309-608X |
| language | English |
| last_indexed | 2024-03-10T13:40:12Z |
| publishDate | 2020-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Fungi |
| spelling | doaj.art-e822c0ff0e7944de91c93d8ae938e7082023-11-21T03:10:35ZengMDPI AGJournal of Fungi2309-608X2020-12-01711710.3390/jof7010017Role and Interpretation of Antifungal Susceptibility Testing for the Management of Invasive Fungal InfectionsFrederic Lamoth0Russell E. Lewis1Dimitrios P. Kontoyiannis2Infectious Diseases Service and Institute of Microbiology, University Hospital of Lausanne, Lausanne University, 1011 Lausanne, SwitzerlandClinic of Infectious Diseases, S’Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, ItalyDepartment of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USAInvasive fungal infections (IFIs) are associated with high mortality rates and timely appropriate antifungal therapy is essential for good outcomes. Emerging antifungal resistance among <i>Candida</i> and <i>Aspergillus</i> spp., the major causes of IFI, is concerning and has led to the increasing incorporation of in vitro antifungal susceptibility testing (AST) to guide clinical decisions. However, the interpretation of AST results and their contribution to management of IFIs remains a matter of debate. Specifically, the utility of AST is limited by the delay in obtaining results and the lack of pharmacodynamic correlation between minimal inhibitory concentration (MIC) values and clinical outcome, particularly for molds. Clinical breakpoints for <i>Candida</i> spp. have been substantially revised over time and appear to be reliable for the detection of azole and echinocandin resistance and for outcome prediction, especially for non-neutropenic patients with candidemia. However, data are lacking for neutropenic patients with invasive candidiasis and some non-<i>albicans Candida</i> spp. (notably emerging <i>Candida auris</i>). For <i>Aspergillus</i> spp., AST is not routinely performed, but may be indicated according to the epidemiological context in the setting of emerging azole resistance among <i>A. fumigatus</i>. For non-<i>Aspergillus</i> molds (e.g., <i>Mucorales</i>, <i>Fusarium</i> or <i>Scedosporium</i> spp.), AST is not routinely recommended as interpretive criteria are lacking and many confounders, mainly host factors, seem to play a predominant role in responses to antifungal therapy. This review provides an overview of the pre-clinical and clinical pharmacodynamic data, which constitute the rationale for the use and interpretation of AST testing of yeasts and molds in clinical practice.https://www.mdpi.com/2309-608X/7/1/17invasive aspergillosisinvasive candidiasismucormycosisclinical breakpointsminimal inhibitory concentrationtherapeutic response |
| spellingShingle | Frederic Lamoth Russell E. Lewis Dimitrios P. Kontoyiannis Role and Interpretation of Antifungal Susceptibility Testing for the Management of Invasive Fungal Infections Journal of Fungi invasive aspergillosis invasive candidiasis mucormycosis clinical breakpoints minimal inhibitory concentration therapeutic response |
| title | Role and Interpretation of Antifungal Susceptibility Testing for the Management of Invasive Fungal Infections |
| title_full | Role and Interpretation of Antifungal Susceptibility Testing for the Management of Invasive Fungal Infections |
| title_fullStr | Role and Interpretation of Antifungal Susceptibility Testing for the Management of Invasive Fungal Infections |
| title_full_unstemmed | Role and Interpretation of Antifungal Susceptibility Testing for the Management of Invasive Fungal Infections |
| title_short | Role and Interpretation of Antifungal Susceptibility Testing for the Management of Invasive Fungal Infections |
| title_sort | role and interpretation of antifungal susceptibility testing for the management of invasive fungal infections |
| topic | invasive aspergillosis invasive candidiasis mucormycosis clinical breakpoints minimal inhibitory concentration therapeutic response |
| url | https://www.mdpi.com/2309-608X/7/1/17 |
| work_keys_str_mv | AT fredericlamoth roleandinterpretationofantifungalsusceptibilitytestingforthemanagementofinvasivefungalinfections AT russellelewis roleandinterpretationofantifungalsusceptibilitytestingforthemanagementofinvasivefungalinfections AT dimitriospkontoyiannis roleandinterpretationofantifungalsusceptibilitytestingforthemanagementofinvasivefungalinfections |