Department of Research, Infectious Diseases Institute and Department of Medical Microbiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.
Infection Sciences, King's College Hospital, London, UK.
Lancet Infect Dis. 2024 Dec;24(12):e782-e793. doi: 10.1016/S1473-3099(24)00429-8. Epub 2024 Sep 18.
Patients infected with antifungal-resistant fungi often do not respond to therapy, substantially increasing mortality risk. Some fungi are inherently resistant to particular antifungals, underscoring the importance of rapid genus identification or, ideally, rapid species identification. The past decade has seen an increase in variable antifungal resistance rates among human fungal pathogens, necessitating individual isolate testing. Various antifungal susceptibility testing (AFST) methods are most suitable for resource-constrained settings, including agar diffusion, gradient diffusion, broth microdilution, and automated tests, which all differ in speed, reliability, and cost; yet AFST remains largely unavailable in resource-constrained settings. This Personal View explores the feasibility of AFST implementation in resource-constrained settings and addresses broader accessibility concerns. We outline seven steps for implementation of AFST with an initial focus on accurate species identification (to predict intrinsic resistance) of Candida albicans, Candida parapsilosis, Candida glabrata, and Aspergillus fumigatus. New funding, laboratory and clinical training, clear protocols, access to media and reagents, acquisition and maintenance of quality control strains, and regular participation in an external quality assurance programme are all essential for sustainable AFST services. AFST is fundamental for patient care guidance, surveillance data generation, and strengthening antifungal stewardship programmes. Political commitment and international collaborations are crucial for enhanced AFST service delivery.
患有抗真菌耐药真菌感染的患者通常对治疗无反应，大大增加了死亡风险。有些真菌本身就对特定的抗真菌药物具有耐药性，这突出表明了快速鉴定属种或理想情况下快速鉴定种的重要性。过去十年中，人类真菌病原体的抗真菌耐药率有所增加，这需要进行个体分离物检测。各种抗真菌药敏试验（AFST）方法最适合资源有限的环境，包括琼脂扩散、梯度扩散、肉汤微量稀释和自动化检测，这些方法在速度、可靠性和成本方面都有所不同；然而，资源有限的环境中仍然主要无法进行 AFST。这篇个人观点探讨了在资源有限的环境中实施 AFST 的可行性，并解决了更广泛的可及性问题。我们概述了在资源有限的环境中实施 AFST 的七个步骤，最初重点是准确鉴定白色念珠菌、近平滑念珠菌、光滑念珠菌和烟曲霉的种（预测固有耐药性）。新的资金、实验室和临床培训、明确的方案、获得和维护质量控制菌株以及定期参与外部质量保证计划，对于可持续的 AFST 服务都是必不可少的。AFST 对于指导患者护理、生成监测数据和加强抗真菌管理计划至关重要。政治承诺和国际合作对于增强 AFST 服务提供至关重要。
