Antifungal Susceptibility Testing: Current Approaches

Clin Microbiol Rev. 2020 Apr 29;33(3):e00069-19. doi: 10.1128/CMR.00069-19. Print 2020 Jun 17.


Although not as ubiquitous as antibacterial susceptibility testing, antifungal susceptibility testing (AFST) is a tool of increasing importance in clinical microbiology laboratories. The goal of AFST is to reliably produce MIC values that may be used to guide patient therapy, inform epidemiological studies, and track rates of antifungal drug resistance. There are three methods that have been standardized by standards development organizations: broth dilution, disk diffusion, and azole agar screening for Aspergillus Other commonly used methods include gradient diffusion and the use of rapid automated instruments. Novel methodologies for susceptibility testing are in development. It is important for laboratories to consider not only the method of testing but also the interpretation (or lack thereof) of in vitro data.

Keywords: CLSI; EUCAST; antifungal resistance; antifungal susceptibility testing; breakpoints; epidemiological cutoff value.

Publication types

  • Review

MeSH terms

  • Antifungal Agents / pharmacology*
  • Aspergillus fumigatus / drug effects
  • Candida / drug effects
  • Clinical Laboratory Techniques / methods*
  • Clinical Laboratory Techniques / standards*
  • Drug Resistance, Fungal
  • Humans
  • Microbial Sensitivity Tests / methods*
  • Microbial Sensitivity Tests / standards*
  • Mycoses / drug therapy
  • Mycoses / microbiology
  • Predictive Value of Tests


  • Antifungal Agents