ANTIFUNGAL SUSCEPTIBILITY TESTING - TECHNICAL ADVANCES AND POTENTIAL CLINICAL-APPLICATIONS

The clinical application of in vitro antifungal susceptibility testing has been limited by a lack of reproducibility and uncertain clinical relevance. As a result of several collaborative studies, the National Committee for Clinical Laboratory Standards (NCCLS) has proposed a sta ndardized antifungal susceptibility test method, NCCLS M27-T. More con venient, user-friendly methods (microdilution broth and stable gradien t technology) have been evaluated, and the potential for a similar pro cess with a disk diffusion method is apparent, Adaptation of the stand ard method for susceptibility testing of filamentous fungi appears pro mising, The existence of a standardized method facilitates meaningful analysis of studies addressing the issue of clinical relevance of anti fungal susceptibility testing, Correlation of MICs with clinical respo nse to therapy is beginning to emerge, most notably in relation to flu conazole and itraconazole therapy for oropharyngeal candidiasis associ ated with infection with the human immunodeficiency virus. This accumu lated experience with antifungal susceptibility testing allows us to p rovide several specific recommendations for antifungal susceptibility testing in the clinical laboratory, Application of this developing tec hnology to new antifungal agents and other disease states will enhance our ability to effectively deal with the emerging problem of fungal i nfection.