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Clinical Microbiology Reviews, October 2001, p. 643-658, Vol. 14, No. 4
0893-8512/01/$04.00+0   DOI: 10.1128/CMR.14.4.643-658.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.

Antifungal Susceptibility Testing: Practical Aspects and Current Challenges

John H. Rex,1,*,dagger Michael A. Pfaller,2,dagger Thomas J. Walsh,3,dagger Vishnu Chaturvedi,4,dagger Ana Espinel-Ingroff,5,dagger Mahmoud A. Ghannoum,6,dagger Linda L. Gosey,7,dagger Frank C. Odds,8,dagger Michael G. Rinaldi,9,dagger Daniel J. Sheehan,10,dagger and David W. Warnock11,dagger

Division of Infectious Diseases, Department of Internal Medicine, Center for the Study of Emerging and Reemerging Pathogens, University of Texas Medical School, Houston, Texas 770301; University of Iowa College of Medicine, Iowa City, Iowa 522422; Infectious Diseases Section, Pediatric Branch, National Cancer Institute, Bethesda, Maryland 208923; New York State Department of Health, Albany, New York 122014; Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia 232985; Department of Dermatology, Case Western Reserve University, Cleveland, Ohio 441066; U.S. Food and Drug Administration, Rockville, Maryland 208577; Institute of Medical Sciences, Aberdeen, United Kingdom8; Veterans Administration Medical Center, San Antonio, Texas 782849; Pfizer Inc., Pfizer Pharmaceuticals Group, New York, New York 1001710; and Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia11

Development of standardized antifungal susceptibility testing methods has been the focus of intensive research for the last 15 years. Reference methods for yeasts (NCCLS M27-A) and molds (M38-P) are now available. The development of these methods provides researchers not only with standardized methods for testing but also with an understanding of the variables that affect interlaboratory reproducibility. With this knowledge, we have now moved into the phase of (i) demonstrating the clinical value (or lack thereof) of standardized methods, (ii) developing modifications to these reference methods that address specific problems, and (iii) developing reliable commercial test kits. Clinically relevant testing is now available for selected fungi and drugs: Candida spp. against fluconazole, itraconazole, flucytosine, and (perhaps) amphotericin B; Cryptococcus neoformans against (perhaps) fluconazole and amphotericin B; and Aspergillus spp. against (perhaps) itraconazole. Expanding the range of useful testing procedures is the current focus of research in this area.

* Corresponding author. Mailing address: 6431 Fannin, 1728 JFB, Houston, TX 77030. Phone: (713) 500-6738. Fax: (713) 500-5495. E-mail: John.H.Rex{at}uth.tmc.edu.

dagger Member of the National Committee on Clinical Laboratory Standards Antifungal Susceptibility Testing Subcommittee.

Clinical Microbiology Reviews, October 2001, p. 643-658, Vol. 14, No. 4
0893-8512/01/$04.00+0   DOI: 10.1128/CMR.14.4.643-658.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.


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