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Antifungal susceptibility testing of Candida in the Clinical Laboratory: how to do it, when to do it, and how to interpret it

Esther Manso, Claudio Farina, Stefano Andreoni, Elisabetta Blasi, Marco Conte, Paolo Fazii, Gianluigi Lombardi, Silvana Sanna
  • Esther Manso
    Comitato di Studio per la Micologia (CoSM), Associazione Microbiologi Clinici Italiani, Milano; Laboratorio di Analisi Chimico-cliniche e Microbiologia, Azienda Ospedaliera-Universitaria Ospedali Riuniti di Ancona, Italy | e.manso@ospedaliriuniti.marche.it
  • Claudio Farina
    Comitato di Studio per la Micologia (CoSM), Associazione Microbiologi Clinici Italiani, Milano; USC Microbiologia e Virologia, Azienda Ospedaliera “Papa Giovanni XXIII”, Bergamo, Italy
  • Stefano Andreoni
    CComitato di Studio per la Micologia (CoSM), Associazione Microbiologi Clinici Italiani, Milano; Laboratorio di Microbiologia e Virologia, Azienda Ospedaliero-Universitaria “Maggiore della Carità di Novara”, Italy
  • Elisabetta Blasi
    Comitato di Studio per la Micologia (CoSM), Associazione Microbiologi Clinici Italiani, Milano; Dipartimento di Medicina Diagnostica, Clinica e Sanità Pubblica, Università degli Studi di Modena e Reggio Emilia, Modena, Italy
  • Marco Conte
    Comitato di Studio per la Micologia (CoSM), Associazione Microbiologi Clinici Italiani, Milano; Laboratorio di Microbiologia e Virologia, Azienda Ospedaliera Specialistica dei Colli “Monaldi-Cotugno-CTO”, Napoli, Italy
  • Paolo Fazii
    Comitato di Studio per la Micologia (CoSM), Associazione Microbiologi Clinici Italiani, Milano; Laboratorio di Microbiologia e Virologia, Ospedale Civile “Santo Spirito”, Pescara, Italy
  • Gianluigi Lombardi
    Comitato di Studio per la Micologia (CoSM), Associazione Microbiologi Clinici Italiani, Milano; Laboratorio di Analisi Chimico-cliniche e Microbiologia, Azienda Ospedaliera “Niguarda – Ca’ Granda”, Milano, Italy
  • Silvana Sanna
    Comitato di Studio per la Micologia (CoSM), Associazione Microbiologi Clinici Italiani, Milano; Servizio di Microbiologia Clinica, Azienda Ospedaliero-Universitaria “Sassari”, Italy

Abstract

Significant changes in the management of fungaemia have occurred in the last decade with increased use of fluconazole prophylaxis, of empirical treatment and of echinocandins as first-line agents for documented disease. The emergence of drug resistance in fungal pathogens has a profound impact on human health given limited number of antifungal drugs. Antifungal resistance in Candida may be either intrinsic or acquired and may be encountered in the antifungal drug exposed but also the antifungal drug naïve patient The variation in resistance rates between centers emphasizes that it is essential to have knowledge of the local Candida species distribution and antifungal resistance rates to guide initial therapy for Candida BSI. Moreover, all Candida isolates from blood and normally sterile sites should be identified to the species level. The Clinical and Laboratory Standards Institute and European Committee on Antimicrobial Susceptibility Testing have developed breakpoints and epidemiological cutoff values that are now established for Candida spp. Clinical microbiology laboratories will be employed commercial susceptibility assays, rather than reference broth microdilution methods and comparative studies are particularly important. Vitek 2®, Etest® and Sensititre YeastOne® provided a high degree of essential agreement and comparable sensitivity and specificity to BMD-RPMI for identifying resistance to azole and echinocandins in Candida spp.

Keywords

Antifungal susceptibility testing, EUCAST, CLSI, Candida, Vitek 2, Sensititre YeastOne, Etest

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Submitted: 2014-03-11 11:32:22
Published: 2014-06-30 00:00:00
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Copyright (c) 2014 Esther Manso, Claudio Farina, Stefano Andreoni, Elisabetta Blasi, Marco Conte, Paolo Fazii, Gianluigi Lombardi, Silvana Sanna

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