Abstract
Since the 1980s, the necessity for a clinically significant drug susceptibility testing method with a high level of reproducibility has increasingly been recognized due to the increased incidence of deep mycosis, a wave of novel antifungal agents introduced to the clinical setting, and the emergence of resistant fungi to antifungal agents (particularly, azole-resitant Candida spp.).Studies on susceptibility testing methods for yeasts that have been vigorously carried on primarily by the National Committee for Clinical Laboratory Standards (NCCLS) in the US came to fruition in the form of the standard method called NCCLS M27. The reproducibility of this method, as well as a favorable correlation between in vitro susceptibility and in vivo clinical effects for Candida spp. and azole antifungal agents, particularly fluconazole (FLCZ), have been confirmed. However, concerning other pathogenic fungi and antifungal agents, there are many issues to be solved in the future, since an in vitro-in vivo correlation has hardly been obtained, and testing methods for candin agents have never been standardized before.In Japan, the Standardization Committee of this Society started working on the establishment of a standard method for commercially available agents in Japan around 1992 when the guidelines for M27-P, the first NCCLS method, were released. The method of this Society was established in compliance with the M27-P method in terms of test media and other basic testing conditions. However, the M27-P method only described a macro-dilution technique, whereas this institute employed a micro-dilution technique that was announced in 1995, and is still available today. The method using such a technique was subsequently commercialized as test kits covered by medical insurance. Meanwhile, the NCCLS also standardized the micro-dilution technique, and this format predominates currently.In this seminar, we will explain the current status of drug susceptibility testing methods for yeasts and related tasks based on the results obtained by the Japan Antifungal Surveillance Program that were implemented by our research group and the discussion on the published literature, and urgent amendments to the assessment criteria of MIC end points used by this Society will be proposed. Therefore, we would like to obtain our Society Members' views on this issue.
