Progress in Antifungal Susceptibility Testing of Candida spp. by Use

Antifungal susceptibility testing of Candida has been standardized and refined and nowmay play a useful role in managing Can-dida infections. Important new developments include validation of 24-h reading times for all antifungal agents and the establish-ment of species-specific epidemiological cutoff values (ECVs) for the systemically active antifungal agents and both common and uncommon species of Candida. The clinical breakpoints (CBPs) for fluconazole, voriconazole, and the echinocandins have been revised to provide species-specific interpretive criteria for the six most common species. The revised CBPs not only are predic-tive of clinical outcome but also provide a more sensitive means of identifying those strains with acquired or mutational resis-tance mechanisms. This brief review serves as an update on the new developments in the antifungal susceptibility testing of Can-dida spp. using Clinical and Laboratory Standards Institute (CLSI) broth microdilution (BMD)methods. The need for reproducible and clinically relevant antifungal sus-ceptibility testing has been prompted by the increasing num-ber of invasive fungal infections (IFIs), the expanding use of anti-fungal agents, and the recognition of antifungal resistance as a