EUCAST and CLSI: Working Together Towards a Harmonized Method for Antifungal Susceptibility Testing |
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Authors: | Ana Espinel-Ingroff Manuel Cuenca-Estrella Emilia Cantón |
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Institution: | 1. VCU Medical Center, 3804 Dover Rd., Richmond, VA, 23221, USA 2. Servicio de Micología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Ctra Majadahonda-Pozuelo Km 2, 28220, Majadahonda, Madrid, Spain 3. Unidad Microbiología Experimental, Centro de Investigación, Hospital Universitario y Politécnico La Fe, Avenida Campanar, 21, 46009, Valencia, Spain
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Abstract: | The U.S. Clinical and Laboratory Standards Institute (CLSI) and the European Committee of Antimicrobial Susceptibility Testing (AFST-EUCAST) have developed broth microdilution methodologies for testing yeasts and filamentous fungi (molds). The mission of these methodologies is to identify in vitro antifungal resistance, which is accomplished by the use of either clinical breakpoints (CBPs), or to a lesser degree, epidemiologic cutoff values (ECVs). The newly adjusted and species-specific CLSI CBPs for Candida spp. versus fluconazole and voriconazole have ameliorated some of the differences between the two methodologies. In the absence of CBPs for mold testing, CLSI ECVs are available for six Aspergillus species versus the triazoles, caspofungin and amphotericin B. Recently, breakpoints were developed by the EUCAST for certain Aspergillus spp. versus amphotercin B, itraconazole and posaconazole, which to some extent are comparable to ECVs. We summarize these latest accomplishments, which have made possible the harmonization of some susceptibility cutoffs, if not methodologies for some agent/species combinations. |
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