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Background <p>Antifungal susceptibility testing (AFST) guides therapy for invasive and refractory fungal infections, but routine testing of species with predictable, species-level (intrinsic) resistance can waste laboratory resources.</p> Methods <p>Narrative synthesis of guideline documents and recent literature to define intrinsic resistance, summarize major fungal examples, and propose a selective AFST framework.</p> Results <p>Key taxa show intrinsic non-susceptibility (e.g., Pichia kudriavzevii to fluconazole; Mucorales to short-tailed azoles; Cryptococcus spp. to echinocandins). Terminology differences between EUCAST and CLSI are noted. Recommended AFST is targeted to invasive/rare pathogens, treatment failure, surveillance, outbreak investigation, and evaluation of novel agents.</p> Conclusion <p>A selective AFST strategy, reserving routine testing for species with variable or emergent resistance, enhances laboratory efficiency and antifungal stewardship while ensuring appropriate clinical therapy.</p>

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When Should Clinical Mycology Laboratories Perform Antifungal Susceptibility Testing? Revisiting Practice Through the Lens of Intrinsic Resistance

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年12月21日

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  • Cornelia Lass-Flörl,
  • Sevtap Arikan-Akdagli

摘要

Background

Antifungal susceptibility testing (AFST) guides therapy for invasive and refractory fungal infections, but routine testing of species with predictable, species-level (intrinsic) resistance can waste laboratory resources.

Methods

Narrative synthesis of guideline documents and recent literature to define intrinsic resistance, summarize major fungal examples, and propose a selective AFST framework.

Results

Key taxa show intrinsic non-susceptibility (e.g., Pichia kudriavzevii to fluconazole; Mucorales to short-tailed azoles; Cryptococcus spp. to echinocandins). Terminology differences between EUCAST and CLSI are noted. Recommended AFST is targeted to invasive/rare pathogens, treatment failure, surveillance, outbreak investigation, and evaluation of novel agents.

Conclusion

A selective AFST strategy, reserving routine testing for species with variable or emergent resistance, enhances laboratory efficiency and antifungal stewardship while ensuring appropriate clinical therapy.