9
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Lo que debemos saber sobre los métodos de sensibilidad a los antifúngicos Translated title: What we must know about antifungal suceptibility testing

      review-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          El aumento creciente de infecciones fúngicas y la aparición de resistencia a los antimicóticos, han hecho necesario el desarrollo de métodos estandarizados para la determinación de la susceptibilidad antifúngica. Tales métodos deben ser reproducibles y adaptables a un laboratorio asistencial, de manera que permitan la detección de resistencia in vitro, la cual, en la mayoría de los casos, suele correlacionarse con una evolución clínica desfavorable. Tanto el Clinical Laboratory Standards Institute, como el European Committee for Antimicrobial Susceptibility Testing han desarrollado guías para la medición estandarizada de la sensibilidad de varias especies de hongos a los antimicóticos actuales. En la literatura científica colombiana son pocos los datos disponibles sobre la sensibilidad antifúngica, por lo que frente al creciente aumento de la resistencia a los antifúngicos, se hace necesario comenzar a recopilar datos propios. En este artículo se hace una revisión de las últimas publicaciones indexadas en Pubmed con relación a los distintos métodos disponibles para medir la sensibilidad antifúngica y, adicionalmente, se destaca su utilidad en la práctica clínica

          Translated abstract

          The increasing number of fungal infections and the emergence of antifungal resistance, have prompted the development of standardized methods for determining antifungal sensitivity profiles, aiming at obtaining reproducible and adaptable tests that could be done in hospital laboratories for the in vitro determination of resistance as, in most cases, data correlate with an unsatisfactory clinical outcome. Both the Clinical Laboratory Standards Institute (CLSI) and the European Committee for Antimicrobial Susceptibility Testing (EUCAST), have developed guidelines for the interpretation of standardized sensitivity measurements of the various fungal species to current antifungal compounds. In the Colombian scientific literature, few data are available on antifungal sensitivity; however, with the increasing number of antifungal resistant isolates, it is necessary to begin collecting our own data. This paper reviews recent publications in PubMed regarding the various methods of antifungal susceptibility testing and highlights their usefulness in clinical practice

          Related collections

          Most cited references57

          • Record: found
          • Abstract: found
          • Article: not found

          Current status of antifungal susceptibility testing methods.

          Antifungal susceptibility testing is a very dynamic field of medical mycology. Standardization of in vitro susceptibility tests by the Clinical and Laboratory Standards Institute (CLSI) and the European Committee for Antimicrobial Susceptibility Testing (EUCAST), and current availability of reference methods constituted the major remarkable steps in the field. Based on the established minimum inhibitory concentration (MIC) breakpoints, it is now possible to determine the susceptibilities of Candida strains to fluconazole, itraconazole, voriconazole, and flucytosine. Moreover, utility of fluconazole antifungal susceptibility tests as an adjunct in optimizing treatment of candidiasis has now been validated. While the MIC breakpoints and clinical significance of susceptibility testing for the remaining fungi and antifungal drugs remain yet unclear, modifications of the available methods as well as other methodologies are being intensively studied to overcome the present drawbacks and limitations. Among the other methods under investigation are Etest, colorimetric microdilution, agar dilution, determination of fungicidal activity, flow cytometry, and ergosterol quantitation. Etest offers the advantage of practical application and favorable agreement rates with the reference methods that are frequently above acceptable limits. However, MIC breakpoints for Etest remain to be evaluated and established. Development of commercially available, standardized colorimetric panels that are based on CLSI method parameters has added more to the antifungal susceptibility testing armamentarium. Flow cytometry, on the other hand, appears to offer rapid susceptibility testing but requires specified equipment and further evaluation for reproducibility and standardization. Ergosterol quantitation is another novel approach, which appears potentially beneficial particularly in discrimination of azole-resistant isolates from heavy trailers. The method is yet investigational and requires to be further studied. Developments in methodology and applications of antifungal susceptibility testing will hopefully provide enhanced utility in clinical guidance of antifungal therapy. However, and particularly in immunosuppressed host, in vitro susceptibility is and will remain only one of several factors that influence clinical outcome.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Issues in antifungal susceptibility testing.

            M. Johnson (2007)
            In line with the availability of an increasing array of systemic antifungal agents, there is a need for accurate, reproducible and predictive susceptibility testing of fungal isolates in order to help inform clinical choice. Much early attention on antifungal susceptibility testing focused on defining test parameters that produced reproducible and reliable intra- and inter-laboratory results and there are now standardized methods for the testing of yeast and mould isolates. The application of this standardized approach produces susceptibility results that are comparable between laboratories and allow epidemiological analyses at the national and even international level. In addition, monitoring and prediction of emerging susceptibility trends are now possible. As methodology improved, attention shifted to clinical outcome data in order to establish breakpoints for antifungal agents. However, there are a large number of confounding factors that must be considered when trying to assess the in vivo activity of antifungal agents in invasive disease. An approach based on defining normal susceptibility ranges, together with pharmacokinetic and pharmacodynamic analyses and identification of resistance mechanisms, has helped to establish breakpoint data for at least some of the systemic agents active against yeast isolates. Moreover, for some drugs, there is a supporting in vitro-in vivo correlation available from studies of clinical efficacy. Application of susceptibility testing has helped to define the spectrum of activity of all the currently available antifungal agents. Both intrinsic and emergent antifungal drug resistance are encountered and the predictability of innate resistance has meant that species identification is often sufficient to alert the clinician to the likelihood of in vitro and often-associated in vivo resistance. Currently, emergence of resistance in a previously susceptible strain during a course of treatment remains rare.
              Bookmark
              • Record: found
              • Abstract: not found
              • Article: not found

              Role of antifungal susceptibility testing in patient management

                Bookmark

                Author and article information

                Contributors
                Role: ND
                Role: ND
                Journal
                cesm
                CES Medicina
                CES Med.
                Universidad CES (Medellín )
                0120-8705
                January 2012
                : 26
                : 1
                : 71-83
                Affiliations
                [1 ] Universidad CES Colombia
                [2 ] Universidad CES Colombia
                Article
                S0120-87052012000100007
                4f589133-ecb2-4edf-b8aa-7163be281ce6

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Colombia

                Self URI (journal page): http://www.scielo.org.co/scielo.php?script=sci_serial&pid=0120-8705&lng=en
                Categories
                MEDICINE, GENERAL & INTERNAL

                Internal medicine
                Sensitivity test for antifungals,Minimal inhibitory concentration,Antifungal,Filamentous fungi,Yeasts,Review,Pruebas de sensibilidad para antifúngicos,Concentración inhibitoria mínima,Antimicóticos,Hongos filamentosos,Levaduras,Revisión

                Comments

                Comment on this article