antimicrobial susceptibility testing in the Management of fungal pathogenesis among immunocompromised hosts

Rohan Sharma; A. Bose; D. Patel

doi:10.5281/zenodo.22812764

Authors

Rohan Sharma Department of Clinical Medical Microbiology, Nile Institute of Clinical Bacteriology Author https://orcid.org/4731-3204-4777-0343
A. Bose Department of Medical Microbiology, Uruguay Center for Medical Microbiology Author https://orcid.org/8666-7522-8450-1890
D. Patel Department of Medical Microbiology, Oder Institute for Advanced Medical Microbiology Author https://orcid.org/7247-3146-2400-9906

DOI:

https://doi.org/10.5281/zenodo.22812764

Keywords:

antifungal susceptibility testing, invasive candidiasis, aspergillosis, immunocompromised host, antifungal resistance

Abstract

Graphical abstract

Background: Invasive fungal disease is a major cause of morbidity and mortality among immunocompromised hosts, and rising rates of intrinsic and acquired antifungal resistance in Candida and Aspergillus species have complicated empirical management.

Objective: This review synthesizes the standardized methods used for antimicrobial (antifungal) susceptibility testing, the interpretive breakpoint frameworks that translate a minimum inhibitory concentration into a clinical category, and the evidence linking susceptibility results to outcome in immunocompromised hosts.

Methods: We synthesized CLSI and EUCAST reference methodologies, IDSA practice guidelines, and primary surveillance, resistance-mechanism, and outcome-correlation studies addressing antifungal susceptibility testing in candidiasis, aspergillosis, and cryptococcosis.

Findings: Fluconazole resistance is common in Candida glabrata and near-universal in Candida auris, triazole-resistant Aspergillus fumigatus is associated with markedly higher mortality when unrecognized, and echinocandin resistance confirmed by FKS mutation correlates with treatment failure in candidemia.

Conclusions: Targeted antimicrobial susceptibility testing, interpreted alongside molecular resistance markers and embedded within antifungal stewardship programs, is now indispensable for managing fungal pathogenesis in immunocompromised hosts.

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