Medicine Laboratory, Nanfang Hospital of Southern Medical University, Guangzhou, 510515, PR China.
Autobio Diagnostics Co., Ltd, Zhengzhou, 450016, PR China.
J Med Microbiol. 2024 Mar;73(3). doi: 10.1099/jmm.0.001811.
The increasing prevalence and growing resistance of fungi present a significant peril to public health. There are only four classes of antifungal medicines available today, and few candidates are in clinical trials. Rapid and sensitive diagnostic techniques are lacking for most fungal pathogens, and those that do exist are expensive or hard to obtain. This study aimed to evaluate the feasibility of a novel automated antifungal susceptibility testing system, Fungus AST, in comparison to the broth microdilution method (BMD) recommended by the Clinical and Laboratory Standards Institute (CLSI). A total of 101 clinical spp. isolates were collected from the Zengcheng Branch of Nanfang Hospital and subjected to antifungal susceptibility testing. Antifungal susceptibility was assessed using the Fungus AST method and the BMD. In this study, we introduce a novel automated antifungal susceptibility testing system, Fungus AST, which detects the turbidity and/or colour intensity of microdilution wells using a four-wavelength detection technology in real time and is designed to match the growth characteristics of strains over time. Based on our analysis, all reportable ranges of Fungus AST were suitable for clinical fungal isolates in PR China. Within ±twofold dilutions, reproducibility was 100 %. Considering the BMD as a referenced method, ten antifungal agents (anidulafungin, caspofungin, micafungin, fluconazole, voriconazole, posaconazole, itraconazole, amphotericin B, 5-flucytosine and nystatin) showed an essential agreement of >95 %. The category agreement of five antifungal agents (anidulafungin, caspofungin, micafungin, fluconazole and voriconazole) was excellent at >90 %. One isolate and voriconazole showed a major error (ME) (1.7 %), and no other ME or very ME agents were found. Given the above, it can be argued that the utilization of Fungus AST is a discretionary automated approach. More improvements are needed in Fungus AST compared to the BMD system for a wider range of clinical isolates, including different types of fungi.
真菌的患病率不断增加和耐药性不断增强，对公众健康构成了重大威胁。目前仅有四类抗真菌药物，且临床试验中候选药物寥寥无几。大多数真菌病原体缺乏快速和敏感的诊断技术，现有的诊断技术要么昂贵，要么难以获得。本研究旨在评估新型自动化抗真菌药敏检测系统 Fungus AST 的可行性，将其与临床和实验室标准协会 (CLSI) 推荐的肉汤微量稀释法 (BMD) 进行比较。共从南方医院增城分院收集了 101 株临床分离的 spp. 菌株进行抗真菌药敏试验。采用 Fungus AST 法和 BMD 法检测真菌的药敏性。在本研究中，我们介绍了一种新型的自动化抗真菌药敏检测系统 Fungus AST，该系统使用四波长检测技术实时检测微稀释孔的浊度和/或颜色强度，旨在随着时间的推移匹配菌株的生长特征。根据我们的分析，Fungus AST 的所有报告范围均适用于中国临床真菌分离株。在 ±2 倍稀释范围内，重复性为 100%。以 BMD 为参考方法，十种抗真菌药物（安尼达弗、卡泊芬净、米卡芬净、氟康唑、伏立康唑、泊沙康唑、伊曲康唑、两性霉素 B、5-氟胞嘧啶和制霉菌素）的一致性>95%。五种抗真菌药物（安尼达弗、卡泊芬净、米卡芬净、氟康唑和伏立康唑）的类别一致性>90%。一种分离株和伏立康唑显示主要错误（ME）（1.7%），没有发现其他 ME 或非常 ME 药物。综上所述，可以认为 Fungus AST 的使用是一种可选的自动化方法。与 BMD 系统相比，Fungus AST 还需要在更广泛的临床分离株，包括不同类型的真菌方面进行更多的改进。
