Has antifungal susceptibility testing come of age?

The in vitro susceptibility of an infecting organism to the antimicrobial agent selected for therapy is one of several factors that influence the likelihood that therapy for an infection will be successful. To appreciate the value of antifungal susceptibility testing, it is helpful to review the overall predictive utility of antibacterial susceptibility testing. After >30 years of study, in vitro susceptibility can be said to predict the response of bacterial infections with an accuracy that is well summarized as the "90-60 rule": infections due to susceptible isolates respond to therapy similar to90% of the time, whereas infections due to resistant isolates respond similar to60% of the time. On the basis of a growing body of knowledge, standardized susceptibility testing for selected organism-drug combinations (most notably, Candida species and the azole antifungal agents) has been shown to have similar predictive utility. Antifungal susceptibility testing is now increasingly and appropriately used as a routine adjunct to the treatment of fungal infections.