Special Issue "Antifungal Susceptibility Testing"

A special issue of Journal of Fungi (ISSN 2309-608X).

Deadline for manuscript submissions: closed (28 February 2017).

Special Issue Editors

Dr. Ana Alastruey-Izquierdo
E-Mail Website
Guest Editor
National Centre for Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
Interests: antifungal susceptibility testing; antifungal resistance; medical mycology; taxonomy; diagnosis of fungal infections; epidemiology
Dr. Stéphane Ranque
E-Mail Website
Guest Editor
Aix Marseille Univ, APHM, IRD, IRBA, IP-TPT, CHU Timone, Parasitology-Mycology, Marseille, France
Interests: medical mycology; diagnosis of fungal infections; epidemiology; fungal identification

Special Issue Information

Dear Colleagues,

For many years, only one compound was available to treat serious fungal infections. Fortunately, in the last few decades, several other drugs and families have been licenced and, nowadays, there are several therapeutic options to treat patients with these diseases. The number of species able to cause fungal infections has increase exponentially in the last few years. These fungal species have different susceptibility profiles that can vary, even within strains of the same species. In addition, as you might know, antifungal resistance is emerging worldwide in the last years threatening the outcome of patients infected with resistant isolates and becoming a public health threat. This resistance is emerging both in Candida and Aspergillus and in azoles and echinocandins. As a result, knowing the antifungal susceptibility profile and detection of antifungal resistance are essential to manage patients affected with fungal infections. Two organizations: The European, EUCAST and the American, CLSI have intensively worked towards standardized methods for antifungal susceptibility testing and have developed interpretative breakpoints to define antifungal resistance. However, other commercial methods are developed providing comparable results that are increasingly used in the clinical setting. Therefore, nowadays, antifungal susceptibility tests have become essential tools to detect resistance, to guide treatment and to study epidemiology in different settings.

Dr. Ana Alastruey-Izquierdo
Dr. Stéphane Ranque
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Fungi is an international peer-reviewed open access quarterly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1000 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • antifungals
  • EUCAST
  • CLSI
  • E-test
  • Sensititre
  • VITEK
  • Resistance
  • Breakpoints
  • azoles
  • echinocandins
  • Candida
  • Aspergillus
  • Cryptococcus
  • Fusarium
  • Scedosporium
  • Mucorales

Published Papers (7 papers)

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Research

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Open AccessArticle
Fungicidal Activity in the Presence of Keratin as an Important Factor Contributing to In Vivo Efficacy: A Comparison of Efinaconazole, Tavaborole, and Ciclopirox
J. Fungi 2017, 3(4), 58; https://doi.org/10.3390/jof3040058 - 19 Oct 2017
Cited by 3
Abstract
Use of oral antifungals in the treatment of onychomycosis is commonplace; but their use can be limited by safety and patient concerns. Due to their broader safety margins, topical antifungals (efinaconazole, tavaborole, and ciclopirox) are a useful option in the treatment of mild-to-moderate [...] Read more.
Use of oral antifungals in the treatment of onychomycosis is commonplace; but their use can be limited by safety and patient concerns. Due to their broader safety margins, topical antifungals (efinaconazole, tavaborole, and ciclopirox) are a useful option in the treatment of mild-to-moderate onychomycosis in the USA, but their antifungal activity has yet to be directly compared. This study aims to identify important factors contributing to in vivo efficacies of the three topical antifungals. Minimum inhibitory concentrations (MICs) were determined by Clinical and Laboratory Standards Institute (CLSI) M38-A2 broth microdilution. The MIC90 values of efinaconazole, tavaborole, and ciclopirox for T. rubrum were 0.0078, 8.0, and 0.50 μg/mL, respectively. The MIC90 values for T. mentagrophytes were 0.016, 8.0, and 0.50 μg/mL, respectively. Efinaconazole showed potent fungicidal activity in keratin-containing medium, whereas tavaborole was fungistatic, and ciclopirox not active. In the guinea pig model of onychomycosis, the therapeutic efficacy of efinaconazole was superior to those of tavaborole and ciclopirox. This study suggests that not only fungistatic activity (MIC), but also fungicidal activity in the presence of keratin, is an important factor contributing to the in vivo efficacy of topical antifungal drugs against onychomycosis. Full article
(This article belongs to the Special Issue Antifungal Susceptibility Testing)
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Open AccessArticle
MIC Distributions and Evaluation of Fungicidal Activity for Amphotericin B, Itraconazole, Voriconazole, Posaconazole and Caspofungin and 20 Species of Pathogenic Filamentous Fungi Determined Using the CLSI Broth Microdilution Method
J. Fungi 2017, 3(2), 27; https://doi.org/10.3390/jof3020027 - 31 May 2017
Cited by 6
Abstract
For filamentous fungi (moulds), species-specific interpretive breakpoints and epidemiological cut-off values (ECVs) have only been proposed for a limited number of fungal species–antifungal agent combinations, with the result that clinical breakpoints are lacking for most emerging mould pathogens. In the current study, we [...] Read more.
For filamentous fungi (moulds), species-specific interpretive breakpoints and epidemiological cut-off values (ECVs) have only been proposed for a limited number of fungal species–antifungal agent combinations, with the result that clinical breakpoints are lacking for most emerging mould pathogens. In the current study, we have compiled minimum inhibitory concentration (MIC) data for 4869 clinical mould isolates and present full MIC distributions for amphotericin B, itraconazole, voriconazole, posaconazole, and caspofungin with these isolates which comprise 20 species/genera. In addition, we present the results of an assessment of the fungicidal activity of these same five antifungal agents against a panel of 123 mould isolates comprising 16 of the same species. Full article
(This article belongs to the Special Issue Antifungal Susceptibility Testing)
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Open AccessArticle
An Assessment of In Vitro Antifungal Activities of Efinaconazole and Itraconazole against Common Non-Dermatophyte Fungi Causing Onychomycosis
J. Fungi 2017, 3(2), 20; https://doi.org/10.3390/jof3020020 - 05 May 2017
Cited by 6
Abstract
Onychomycosis is a fungal nail infection which is relatively common and difficult to treat. Treatment modalities include nail avulsion, surgical debridement and combination therapy with oral and topical antifungal drugs. In spite of a host of available drugs, clinical cure rates remain discouraging. [...] Read more.
Onychomycosis is a fungal nail infection which is relatively common and difficult to treat. Treatment modalities include nail avulsion, surgical debridement and combination therapy with oral and topical antifungal drugs. In spite of a host of available drugs, clinical cure rates remain discouraging. Drug toxicities, prolonged regimens, lack of patient compliance, and high keratin affinity of drugs are all contributive factors. Efinaconazole is a novel topical triazole antifungal agent that has shown excellent in vitro activity against both dermatophyte and non-dermatophyte fungi causing onychomycosis. This study presents the in vitro susceptibility profiles of 44 common non-dermatophyte fungi against efinaconazole and itraconazole, another azole drug used in the treatment of onychomycosis. Full article
(This article belongs to the Special Issue Antifungal Susceptibility Testing)
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Open AccessArticle
Molecular Identification and Antifungal Susceptibility Patterns of Clinical Dermatophytes Following CLSI and EUCAST Guidelines
J. Fungi 2017, 3(2), 17; https://doi.org/10.3390/jof3020017 - 23 Mar 2017
Cited by 9
Abstract
Dermatophytes are associated with superficial infections in humans worldwide. The aim of the present study was to determine the species distribution and susceptibility patterns of clinical dermatophytes. Samples received for routine mycological processing from 124 suspected cases attending a dermatologic clinic in a [...] Read more.
Dermatophytes are associated with superficial infections in humans worldwide. The aim of the present study was to determine the species distribution and susceptibility patterns of clinical dermatophytes. Samples received for routine mycological processing from 124 suspected cases attending a dermatologic clinic in a tertiary care hospital were included in the study. On direct microscopy, 74.1% (92/124) were positive and 53.2% (66/124) grew on culture. The isolates were comprised of Trichophyton interdigitale (56%) followed by Trichophyton tonsurans (25.7%), Trichophyton rubrum (7.5%), Trichophyton violaceum (4.5%), Microsporum gypseum (4.5%), and Trichophyton verrucosum (1.5%). Conventional mycological identification was concordant with ITS sequencing except for T. mentagrophytes. High minimum inhibitory concentration (MIC) values (geometric mean, >1 µg/mL) were observed for T. tonsurans and T. rubrum to terbinafine and griseofulvin. This study highlights the shift in epidemiology from T. rubrum to T. interdigitale. It also raises a concern of high MICs of terbinafine and griseofulvin among our isolates. Surveillance of antifungal susceptibility patterns can provide clinicians with local MIC data that can further aid in guiding better management in relapse cases of dermatomycosis. Full article
(This article belongs to the Special Issue Antifungal Susceptibility Testing)
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Review

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Open AccessReview
Methodological Issues in Antifungal Susceptibility Testing of Malassezia pachydermatis
J. Fungi 2017, 3(3), 37; https://doi.org/10.3390/jof3030037 - 05 Jul 2017
Cited by 4
Abstract
Reference methods for antifungal susceptibility testing of yeasts have been developed by the Clinical and Laboratory Standards Institute (CLSI) and the European Committee on Antibiotic Susceptibility Testing (EUCAST). These methods are intended to test the main pathogenic yeasts that cause invasive infections, namely [...] Read more.
Reference methods for antifungal susceptibility testing of yeasts have been developed by the Clinical and Laboratory Standards Institute (CLSI) and the European Committee on Antibiotic Susceptibility Testing (EUCAST). These methods are intended to test the main pathogenic yeasts that cause invasive infections, namely Candida spp. and Cryptococcus neoformans, while testing other yeast species introduces several additional problems in standardization not addressed by these reference procedures. As a consequence, a number of procedures have been employed in the literature to test the antifungal susceptibility of Malassezia pachydermatis. This has resulted in conflicting results. The aim of the present study is to review the procedures and the technical parameters (growth media, inoculum preparation, temperature and length of incubation, method of reading) employed for susceptibility testing of M. pachydermatis, and when possible, to propose recommendations for or against their use. Such information may be useful for the future development of a reference assay. Full article
(This article belongs to the Special Issue Antifungal Susceptibility Testing)
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Open AccessReview
Antifungal Susceptibility Testing of Fusarium: A Practical Approach
J. Fungi 2017, 3(2), 19; https://doi.org/10.3390/jof3020019 - 26 Apr 2017
Cited by 14
Abstract
In vitro susceptibility testing of Fusarium is becoming increasingly important because of frequency and diversity of infections and because resistance profiles are species-specific. Reference methods for antifungal susceptibility testing (AFST) are those of Clinical and Laboratory Standards Institute (CLSI) and European Committee on [...] Read more.
In vitro susceptibility testing of Fusarium is becoming increasingly important because of frequency and diversity of infections and because resistance profiles are species-specific. Reference methods for antifungal susceptibility testing (AFST) are those of Clinical and Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility (EUCAST), but breakpoints (BPs) have not yet been established. One of the problems is that phylogenetic distances between Fusarium species are much smaller than between species of, e.g., Candida. Epidemiological cutoff values (ECVs) for some Fusarium species have been determined in order to differentiate wild-type from non-wild-type isolates. In clinical routine, commercially available assays such as Etest, Sensititre or others provide essential agreement with reference methods. Our objective is to summarize antifungal susceptibility testing of Fusarium genus in the clinical laboratory: how to do it, when to do it, and how to interpret it. Full article
(This article belongs to the Special Issue Antifungal Susceptibility Testing)
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Open AccessReview
Reduced Multidrug Susceptibility Profile Is a Common Feature of Opportunistic Fusarium Species: Fusarium Multi-Drug Resistant Pattern
J. Fungi 2017, 3(2), 18; https://doi.org/10.3390/jof3020018 - 10 Apr 2017
Cited by 5
Abstract
The resistance among various opportunistic Fusarium species to different antifungal agents has emerged as a cause of public health problems worldwide. Considering the significance of multi-drug resistant (MDR), this paper emphasizes the problems associated with MDR and the need to understand its clinical [...] Read more.
The resistance among various opportunistic Fusarium species to different antifungal agents has emerged as a cause of public health problems worldwide. Considering the significance of multi-drug resistant (MDR), this paper emphasizes the problems associated with MDR and the need to understand its clinical significance to combat microbial infections. The search platform PubMed/MEDLINE and a review of 32 cases revealed a common multidrug-resistant profile exists, and clinically relevant members of Fusarium are intrinsically resistant to most currently used antifungals. Dissemination occurs in patients with prolonged neutropenia, immune deficiency, and especially hematological malignancies. Amphotericin B displayed the lowest minimum inhibitory concentrarions (MICs) followed by voriconazole, and posaconazole. Itraconazole and fluconazole showed high MIC values, displaying in vitro resistance. Echinocandins showed the highest MIC values. Seven out of ten (70%) patients with neutropenia died, including those with fungemia that progressed to skin lesions. Clinical Fusarium isolates displayed a common MDR profile and high MIC values for the most available antifungal agents with species- and strain-specific differences in antifungal susceptibility. Species identification of Fusarium infections is important. While the use of natamycin resulted in a favorable outcome in keratitis, AmB and VRC are the most used agents for the treatment of fusariosis in clinical settings. Full article
(This article belongs to the Special Issue Antifungal Susceptibility Testing)
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