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Methodology: Broth Microdilution
Edit Date: 11/24/2008
Components: Amphotericin B / Caspofungin / 5-flurocytosine / Itraconazole / Micafungin / Posaconazole / Anidulafungin / Fluconazole / Voriconazole
Performed: Daily
Released: 2-4 days after setup at PeaceHealth Laboratories’ reference lab
CPT Code: 87186-90
Specimen Collection Details
Collection: Viable organism in pure culture on fungal medium slant.
Handling: Indicate organism identification and source. Candida Species, Cryptococcus, Geotrichum, and Trichosporon Species are tested.
Stability: 14 days ambient or 14 days refrigerated. Unstable frozen.
Transport: Ambient or refrigerated. Send organism in double container according to Infectious Substance Shipping Guidelines.
Comments: Interpretive guidelines are provided only for Candida species.
Rejection Criteria: Non-viable organism; mixed cultures; leaking container.

Reference Range:
For amphotericin B, there are no CLSI breakpoints, but MIC greater than 1 is considered resistant.

Flucytosine MIC breakpoints are based largely on historical data and partially on the drug’s pharmacokinetics.

For fluconazole the guidelines are based on experience with mucosal and invasive infections due to Candida species. When the isolate is C. glabrata and the MIC is less than or equal to 32 µg/mL the maximum dosage regimen should be used.

For intraconazole, the data are based entirely on experience with mucosal infections, and data supporting breakpoints for invasive infections due to Candida spp. are not available.
Voriconazole MIC interpretation is used as surrogate for posaconazole interpretation.

Susceptible Dose Dependent (SDD) applies to fluconazole and itraconazole. Susceptible is dependent on achieving the maximum possible level.

For anidulafungin, caspofungin and micafungin, the data are based substantially on experience with non-neutropenic patients with candidemia. Clinical relevance in other settings is uncertain.

Susceptibility testing is performed by CLSI-approved broth microdilution method.

PeaceHealth Laboratories