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Factors influencing susceptibility testing of antifungal drugs: a critical review of document M27-A4 from the Clinical and Laboratory Standards Institute (CLSI)

  • Clinical Microbiology - Review
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Abstract

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.

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Authors and Affiliations

  1. Graduate Program in Pharmaceutical Sciences, Federal University of Amazonas – UFAM, Manaus, Amazonas, Brazil

    Edinaira Sulany Oliveira de Sousa

  2. Department of Medical Microbiology, National Institute for Amazonian Research – INPA, André Araújo Avenue, Manaus, Amazonas, Brazil

    Ana Claúdia Alves Cortez & João Vicente Braga de Souza

  3. Department of Mycology, Adolfo Lutz Institute, Av. Dr. Arnaldo, Sao Paulo, Brazil

    Marcia de Souza Carvalho Melhem

  4. School of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil

    Marcia de Souza Carvalho Melhem

  5. Department of Tropical Medicine at the Bernhard Nocht Institute, German Armed Forces Hospital of Hamburg, Hamburg, Germany, Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany

    Hagen Frickmann

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  1. Edinaira Sulany Oliveira de Sousa
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  2. Ana Claúdia Alves Cortez
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Correspondence to João Vicente Braga de Souza.

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de Sousa, E.S.O., Cortez, A.C.A., de Souza Carvalho Melhem, M. et al. Factors influencing susceptibility testing of antifungal drugs: a critical review of document M27-A4 from the Clinical and Laboratory Standards Institute (CLSI). Braz J Microbiol 51, 1791–1800 (2020). https://doi.org/10.1007/s42770-020-00354-6

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