Antifungal susceptibility testing has developed rapidly during the last
decade. Through the intensive collaborative work, the National Committee
for Clinical Laboratory Standards(NCCLS) has published a standardized antifungal
susceptibility method M27-A which included interpretive guidelines for
3 antifungal agents. Meaningful large-scale, longitudinal studies of antifungal
susceptibility and resistance, based on standardized methodology and interpretive
guidelines, have been published and serve as the basis for analysis of
resistance trends. Resistant isolates have been further characterized using
molecular biological techniques. Candida albicans and related species become
resistant to antifungal agents, in particular triazoles, by expression
of efflux pomps that reduce drug accumulation, alteration of the structure
or concentration of antifungal target enzymes, and alteration of membrane
sterol composition. On the other hand, there are several ongoing problems
in antifungal susceptibility testing such as trailing phenomenon, ability
to detect amphotericin B resistance, and application for other fungal pathogens.
In this paper, we review studies which focused on the reliability of antifungal
susceptibility testing, epidemiology of resistant isolates, and resistant
mechanisms. Furthermore, we provide several recommendations for antifungal
susceptibility testing in the clinical laboratory.
[Rinsho Byori 50 : 853`589, 2002]
*1Department of Laboratory Medicine, Kinki University school of Medicine, Osakasayama 589-8511
yKey Wordszmycosis(^Ϋ΄υΗ)Cantifungal resistance(R^ΫάΟ«)Cantifungal susceptibility test-ing(R^Ϋά΄σ«±)Cmechanisms of resistance(Ο«@\)
*1,2ίEεwγwΥ°Έγw³Ί(§589-8511 εγ·Rsεμ377-2)
E-mail :yamazumi@med.kindai.ac.jp