Paving the Way to Overcome Antifungal Drug Resistance: Current Practices and Novel Developments for Rapid and Reliable Antifungal Susceptibility Testing

Background:Candidainfections are responsible for increased morbidity and mortality rates in at-risk patients, especially in developing countries where there is limited access to antifungal drugs and a high burden of HIV co-infection. Objectives:This study aimed to identify antifungal drug resistance patterns within the subcontinent of Africa. Methods: A literature search was conducted on published studies that employed antifungal susceptibility testing on clinicalCandidaisolates from sub-Saharan African countries using Pubmed and Google Scholar. Results: A total of 21 studies from 8 countries constituted this review. Only studies conducted in sub-Saharan Africa and employing antifungal drug susceptibility testing were included. Regional differences inCandidaspecies prevalence and resistance patterns were identified. Discussion: The outcomes of this review highlight the need for a revision of antifungal therapy guidelines in regions most affected byCandidadrug resistance. Better controls in antimicrobial drug distribution and the implementation of regional antimicrobial susceptibility surveillance programmes are required in order to reduce the highCandidadrug resistance levels seen to be emerging in sub-Saharan Africa.

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Candida antifungal drug resistance in sub-Saharan African populations: A systematic review

F1000Research ◽

10.12688/f1000research.10327.1 ◽

2016 ◽

Vol 5 ◽

pp. 2832

Author(s):

Charlene Wilma Joyce Africa ◽

Pedro Miguel dos Santos Abrantes

Keyword(s):

Drug Resistance ◽

Susceptibility Testing ◽

Antifungal Susceptibility ◽

Antifungal Drugs ◽

Antifungal Drug ◽

Sub Saharan Africa ◽

African Countries ◽

Antifungal Drug Resistance ◽

Resistance Patterns ◽

Sub Saharan

Background:Candidainfections are responsible for increased morbidity and mortality rates in at-risk patients, especially in developing countries where there is limited access to antifungal drugs and a high burden of HIV co-infection. Objectives:This study aimed to identify antifungal drug resistance patterns within the subcontinent of Africa. Methods: A literature search was conducted on published studies that employed antifungal susceptibility testing on clinicalCandidaisolates from sub-Saharan African countries using Pubmed and Google Scholar. Results: A total of 21 studies from 8 countries constituted this review. Only studies conducted in sub-Saharan Africa and employing antifungal drug susceptibility testing were included. Regional differences inCandidaspecies prevalence and resistance patterns were identified. Discussion: The outcomes of this review highlight the need for a revision of antifungal therapy guidelines in regions most affected byCandidadrug resistance. Better controls in antimicrobial drug distribution and the implementation of regional antimicrobial susceptibility surveillance programmes are required in order to reduce the highCandidadrug resistance levels seen to be emerging in sub-Saharan Africa.

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Antifungal Susceptibility Testing: Current Approaches

Clinical Microbiology Reviews ◽

10.1128/cmr.00069-19 ◽

2020 ◽

Vol 33 (3) ◽

Cited By ~ 4

Author(s):

Elizabeth L. Berkow ◽

Shawn R. Lockhart ◽

Luis Ostrosky-Zeichner

Keyword(s):

Susceptibility Testing ◽

Antifungal Susceptibility ◽

Epidemiological Studies ◽

Antifungal Susceptibility Testing ◽

Antifungal Drug Resistance ◽

Development Organizations ◽

Gradient Diffusion ◽

Antibacterial Susceptibility ◽

Automated Instruments

SUMMARY Although not as ubiquitous as antibacterial susceptibility testing, antifungal susceptibility testing (AFST) is a tool of increasing importance in clinical microbiology laboratories. The goal of AFST is to reliably produce MIC values that may be used to guide patient therapy, inform epidemiological studies, and track rates of antifungal drug resistance. There are three methods that have been standardized by standards development organizations: broth dilution, disk diffusion, and azole agar screening for Aspergillus. Other commonly used methods include gradient diffusion and the use of rapid automated instruments. Novel methodologies for susceptibility testing are in development. It is important for laboratories to consider not only the method of testing but also the interpretation (or lack thereof) of in vitro data.

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Antifungal susceptibility testing of candida – Methods and issues in current practice

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v10i3.1372 ◽

2019 ◽

Vol 10 (3) ◽

pp. 1778-1784

Author(s):

Lakshmi Krishnasamy ◽

Priya Santharam ◽

Chitralekha Saikumar

Keyword(s):

Current Practice ◽

Antifungal Agents ◽

Susceptibility Testing ◽

Fungal Infections ◽

Antifungal Susceptibility ◽

Antifungal Susceptibility Testing ◽

Antifungal Drugs ◽

Testing Methods ◽

Antifungal Drug Resistance ◽

Resistant Strains

Despite the availability of many antifungal drugs in clinical practice, the occurrence of antifungal drug resistance is on the rise. Since the antifungal susceptibility testing (AFST) is not done routinely in many of the microbiology laboratories, it is very difficult to determine which antifungal agent is very effective for a particular infection. There is a real need for precise, reproducible and extrapolative antifungal susceptibility testing methods to aid the therapeutic management. The practice of empirical treatment for fungal infections further promotes the emergence of resistant strains. The AFST practice would essentially help the clinicians in appropriate decision making. Although conventional AFST methods are somewhat cumbersome, many novel AFST methods are currently available in many laboratory settings which would provide a quicker result many times. In essence, the application of AFST along with identification of the fungus up to species level would definitely be very helpful in selecting the primary antifungal agents for treatment especially in difficult to manage and invasive fungal infections. This review will throw light on the various AFST methods available and their issues in the current practice.

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Antifungal susceptibility testing and resistance

10.1093/med/9780198755388.003.0047 ◽

2017 ◽

Author(s):

Elizabeth M. Johnson

Keyword(s):

Antifungal Agents ◽

Susceptibility Testing ◽

Clinical Laboratory ◽

Antifungal Susceptibility ◽

Invasive Disease ◽

Fungal Species ◽

Antifungal Susceptibility Testing ◽

Limiting Factors ◽

Antifungal Drug Resistance

The availability of choice of systemically active antifungal agents and the proliferation in the number of fungal species implicated in invasive disease have meant that clinicians are increasingly looking for guidance from clinical laboratory results to help select the most appropriate agent. There are now well-established and predictable patterns of innate in vitro resistance to one or more antifungal agents associated with many yeast and mould species. This chapter provides definitions for the most frequently used terminology and outlines some of the issues surrounding antifungal susceptibility testing with yeast and mould isolates. Reference methods published by the Clinical Laboratory Standards Institute (CLSI) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST) are discussed. Both innate and emergent antifungal drug resistance are increasingly recognized as limiting factors in the selection of antifungal agents, and the epidemiology and mechanisms of resistance are described for each of the major classes of antifungal agent.

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Detection of Candida auris Antifungal Drug Resistance Markers Directly from Clinical Skin Swabs

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01754-19 ◽

2019 ◽

Vol 63 (12) ◽

Cited By ~ 4

Author(s):

Milena Kordalewska ◽

Annie Lee ◽

Yanan Zhao ◽

David S. Perlin

Keyword(s):

Drug Resistance ◽

Antifungal Susceptibility ◽

Rapid Assessment ◽

Rapid Identification ◽

Antifungal Drug ◽

Infection Prevention And Control ◽

Molecular Diagnostic ◽

Candida Auris ◽

Content Type ◽

Antifungal Drug Resistance

ABSTRACT Accurate and rapid assessment of Candida auris antifungal drug resistance is crucial for effective infection prevention and control actions, as well as for patient management. Here, performance of a molecular diagnostic platform, enabling rapid identification of FKS1 and ERG11 mutations conferring echinocandin and azole resistance, respectively, was evaluated on a panel of clinical skin swabs. Gene sequencing and antifungal susceptibility testing were used as the gold standard. All swabs were correctly categorized as harboring wild-type or mutant C. auris.

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