Antifungal Susceptibility Testing – Moulds and Yeasts (Amphotericin B, Nystatin, Natamycin, 5-Fluorocytosine, Caspofungin, Anidulafungin, Micafungin, Fluconazole, Itraconazole, Ketoconazole, Miconazole, Clotrimazole, Terconazole, Voriconazole, Posaconazole, Isavuconazole, Terbinafine, Griseofulvin)

CPT Code(s)

87188 (mould), 87186 (yeast)

Synonym(s)

Mould MIC (Amphotericin B = AMB, Nystatin = NYS, Natamycin = NAT, 5-Fluorocytosine = 5-FC, Caspofungin = CAS, Anidulafungin = ANID, Micafungin = MICA, Fluconazole = FLU, Itraconazole = ITRA, Ketoconazole = KETO, Miconazole = MON, Clotrimazole = CLOT, Terconazole = TERC, Voriconazole = VORI, Posaconazole = POS, Isavuconazole = ISA, Terbinafine = TERB, Griseofulvin = GRIS)

Performed

In-House

Methodology

Antifungal susceptibility testing is performed by microdilution or macrodilution susceptibility testing according to the methods set forth in the Clinical and Laboratory Standards Institute (CLSI) M38 reference standard filamentous fungi, and by broth microdilution or macrodilution susceptibility testing against yeasts according to the CLSI M27 reference standard.

Panel/Profile Components

Testing tailored to requests for submitting laboratory/physician. Azole panel (fluconazole, voriconazole, itraconazole, posaconazole) and amphotericin/echinocandin panel (amphotericin B, anidulafungin, caspofungin, micafungin) available if requested. Otherwise, individual drugs or combinations of agents tested per request.

Critical Values

N/A

Specimen Collection / Handling Requirements

A pure culture of organism on solid agar (plate or slant) at room temperature is required. Universal precautions should be used for handling fungal cultures.

Minimum Specimen Requirements

A pure culture of organism on solid agar (plate or slant) is required.

Turnaround time

a.        Total testing time: 1 to 10 days from receipt of culture (species dependent)

b.        Results to Client: <10 business days from receipt of culture

Communication

a.        Turnaround time non-conformity: Email or call Pathologist on request form to notify them of the delay.

b.        Specimen rejection: Cause for specimen rejection is noted after the sample has arrived at UT Health San Antonio and the Pathologist on the request form or applicable personnel will be contacted by email or phone.
c.        Technical Updates: Email Applicable Laboratory Director.

Quality

Quality controls run for each drug at each set-up of assay according to CLSI M38- A2 and M27-A3 reference standard recommendations. QC MICs reviewed by medical technologist before release of results and reviewed once weekly by director.