ArticleClinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases2025
Candida auris MIC testing by EUCAST and clinical and laboratory standards institute broth microdilution, and gradient diffusion strips; to be or not to be amphotericin B resistant?
Article in Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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10 citing papers in PubMed.
- Evaluation of Sensititre YeastOne for antifungal susceptibility testing ofJournal of clinical microbiology · 2026Article
- Novel Antifungal Pyridine Alkaloids from Endophytic FungusJournal of fungi (Basel, Switzerland) · 2026Article
- Deciphering the multidrug resistance paradigm inAntimicrobial agents and chemotherapy · 2026Review
- Review
- Comparative assessment of the broth microdilution and VITEK 2 systems for antifungal susceptibility testing of Candida auris (Candidozyma auris) Isolates.BMC microbiology · 2026Article
- Candidozyma auris in The Netherlands: No Evidence of Nosocomial Transmission Supported by Effective Infection Control Policies.Mycopathologia · 2026Article
- Acquired amphotericin B resistance attributed to a mutatedAntimicrobial agents and chemotherapy · 2025Article
- Biocide, antifungal susceptibility and virulence characteristics of Clade 1 Candidozyma auris strains.Annals of clinical microbiology and antimicrobials · 2025Article
- Evaluation of the MIC test strips for antifungal susceptibility testing ofJournal of clinical microbiology · 2025Article
- Head-to-Head Comparison of Etest, MICRONAUT-AM EUCAST and Reference Broth Microdilution-Based CLSI Results forJournal of fungi (Basel, Switzerland) · 2025Article
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Abstract
objectivesReported amphotericin B resistance rates for Candida auris vary considerably. This may reflect clinically relevant differences in susceptibility, technical issues with testing, or adoption of a clinical breakpoint that bisects the wild-type population. We compared reference methods and two gradient diffusion strips using a shared C. auris strain collection.
methodsForty C. auris strains from nine U.S. states and ≥3 clades were included. Fourteen MIC data sets were generated using European Committee on Antimicrobial Susceptibility Testing (EUCAST) E.Def 7.4, Clinical and Laboratory Standards Institute (CLSI) M27Ed4, Etest, and MIC gradient test strip (MTS, Liofilchem) MICs. MICs ≤1 mg/L were classified as susceptible.
resultsEUCAST and CLSI amphotericin B MIC testing were robust across the included method variables. The modal MIC was 1 mg/L, distributions unimodal and narrow with similar geometric mean (GM)-MICs (0.745-1.072); however, susceptibility classification varied (0-28% resistance). Gradient diffusion strip testing resulted in wider and bimodal distributions for 8/9 data sets. If adopting, per manufacturer's protocol, double inoculation for the Etest method, the modal MIC increased to 2-4 mg/L and resistance rates to 45-63% versus 25-30% with the single inoculation. The EUCAST, CLSI, Etest, and MTS strip MICs correlated to the optical density of drug-free control EUCAST wells, suggesting that some isolates grew better than others and that this was associated with MIC. DISCUSSION: The EUCAST and CLSI MIC results were in close agreement, whereas the strip test showed wider and bimodal distributions with reader to reader and centre to centre variation. Our study adds to the concern for commercial MIC testing of amphotericin B against C. auris and suggests the current breakpoint leads to random susceptibility classification.
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