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Has antifungal susceptibility testing come of age
Abstract
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.
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“Pfaller et al. [46] set forth fluconazole clinical breakpoints that met the so-called “90–60” rule, whereby treatment success is achieved for ~90% of susceptible isolates and ~60% of non-susceptible isolates.”
From Treatment of Invasive Candidiasis: A Narrative Review (2018) · cites this paper as [46]
In the citing paper
“Susceptibility testing to fluconazole using CLSI or EUCAST broth microdilution methodology produces MIC values that correlate reasonably well with the likelihood of successful treatment outcomes [46,47].”
From Treatment of Invasive Candidiasis: A Narrative Review (2018) · cites this paper as [46]
In the citing paper
“Intensive efforts to develop standardized, reproducible, and clinically relevant susceptibility testing methods for fungi have resulted in the development of the NCCLS M27-A methodology (now updated with the essentially identical M27-A2 methodology) for susceptibility testing of yeasts [27,28].”
From Guidelines for Treatment of Candidiasis (2004) · cites this paper as [27]
In the citing paper
“Second, the data may be used to support a change in therapy from a parenteral agent of any class to oral fluconazole.”
From Guidelines for Treatment of Candidiasis (2004) · cites this paper as [27]
In the citing paper
“First, susceptibility is useful in the evaluation of the possible causes of lack of clinical response.”
From Guidelines for Treatment of Candidiasis (2004) · cites this paper as [27]
In the citing paper
“susceptibility testing may be used to identify isolates that are less likely to respond to fluconazole (A-II) or amphotericin B (B-II) (table 3) [27,30].”
From Guidelines for Treatment of Candidiasis (2004) · cites this paper as [27]
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Neely, M. N., & Reed, M. D. (2012) · Elsevier eBooks · doi:10.1016/b978-1-4377-2702-9.00293-2 · Cited by 2
Metadata
- Authors
- Rex, J. H., & Pfaller, M. A.
- Affiliations
- Texas Medical Center (US)
- University of Iowa (US)
- Corresponding author
- Rex, John H.
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2002-10-15
- Volume
- 35
- Issue
- 8
- Pages
- 982-989
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- OpenAlex
- W2118836068
- Cited by
- 361
- References
- 64
- Citations by year
- 2026: 5 · 2025: 5 · 2024: 10 · 2023: 11 · 2022: 13 · 2021: 8 · 2020: 17 · 2019: 10 · 2018: 16 · 2017: 21 · 2016: 13 · 2015: 14 · 2014: 24 · 2013: 17 · 2012: 14
- FWCI
- 10.38
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Health Sciences › Medicine › Microbiology (medical) › Bacterial Identification and Susceptibility Testing
- Health Sciences › Medicine › Infectious Diseases › Fungal Infections and Studies
- Keywords
- antifungal susceptibility testing, in vitro susceptibility, predictive utility, antifungal resistance, Candida species, azole antifungals, fungal infection, treatment response
- MeSH terms
- Amphotericin B, Antifungal Agents, Azoles, Candida, Clinical Trials as Topic, Flucytosine, Humans, Microbial Sensitivity Tests, Statistics as Topic
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