Paving the Way to Overcome Antifungal Drug Resistance: Current Practices and Novel Developments for Rapid and Reliable Antifungal Susceptibility Testing

The past year has established the link between the COVID-19 pandemic and the global spread of severe fungal infections; thus, underscoring the critical need for rapid and realizable fungal disease diagnostics. While in recent years, health authorities, such as the Centers for Disease Control and Prevention, have reported the alarming emergence and spread of drug-resistant pathogenic fungi and warned against the devastating consequences, progress in the diagnosis and treatment of fungal infections is limited. Early diagnosis and patient-tailored therapy are established to be key in reducing morbidity and mortality associated with fungal (and cofungal) infections. As such, antifungal susceptibility testing (AFST) is crucial in revealing susceptibility or resistance of these pathogens and initiating correct antifungal therapy. Today, gold standard AFST methods require several days for completion, and thus this much delayed time for answer limits their clinical application. This review focuses on the advancements made in developing novel AFST techniques and discusses their implications in the context of the practiced clinical workflow. The aim of this work is to highlight the advantages and drawbacks of currently available methods and identify the main gaps hindering their progress toward clinical application.

Automated summary

The past year has highlighted the critical need for rapid and feasible fungal disease diagnostics due to the link between the COVID-19 pandemic and the global spread of severe fungal infections. Although progress in the diagnosis and treatment of fungal infections is limited, early diagnosis and patient-tailored therapy are key in reducing morbidity. Antifungal susceptibility testing plays a crucial role in initiating correct antifungal therapy, but current gold standard methods are time-consuming, limiting their clinical application. This review focuses on the advancements in novel AFST techniques and their implications in clinical workflow, aiming to identify gaps hindering progress towards clinical application.