Due to the increasing numbers of fungal infections and the emergence of drug-resistant fungi, optimization and standardization of diagnostic methods for the measurement of antifungal susceptibility are ongoing. The M27-A4 document by the US Clinical and Laboratory Standards Institute (CLSI) is presently used for the interpretation of minimum inhibitory concentrations of major opportunistic yeast species as measured by broth microdilution testing in many countries. Although microdilution is considered a benchmark for reproducible and accurate results, increased testing capacity, and limited human bias, the method is often inaccessible to routine clinical laboratories and researchers, especially in low-income countries. Furthermore, several studies suggest that there are still a considerable number of factors that make the estimation of in vitro activity of antifungal agents challenging. This review article summarizes the limitations of the M27-A4 standard which, despite the advances and improvements obtained by the standardization of antimicrobial resistance testing methods by CLSI, still persist.

中文翻译：

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影响抗真菌药物药敏试验的因素：临床和实验室标准协会 (CLSI) 文件 M27-A4 的批判性审查

由于真菌感染数量的增加和耐药真菌的出现，用于测量抗真菌敏感性的诊断方法的优化和标准化正在进行中。美国临床和实验室标准协会 (CLSI) 的 M27-A4 文件目前用于解释在许多国家通过肉汤微量稀释测试测量的主要机会性酵母菌种的最低抑制浓度。尽管微量稀释被认为是可重复和准确结果、提高测试能力和有限人为偏见的基准，但常规临床实验室和研究人员通常无法使用该方法，尤其是在低收入国家。此外，几项研究表明，仍有相当多的因素使抗真菌剂体外活性的估计具有挑战性。这篇评论文章总结了 M27-A4 标准的局限性，尽管通过 CLSI 对抗菌素耐药性测试方法的标准化取得了进步和改进，但仍然存在。