TABLE 3.
Current antifungal clinical breakpoints and interpretive categories for yeasts and molds via 2019 CLSI and EUCAST standards of broth microdilutiona
| Antifungal agent | Species | CLSI breakpoint (μg/ml) |
EUCAST breakpoint (mg/liter) |
||||||
|---|---|---|---|---|---|---|---|---|---|
| S | I | SDD | R | S | I | SDD | R | ||
| Anidulafungin | C. albicans | ≤0.25 | 0.5 | — | ≥1 | ≤0.032 | — | — | >0.032 |
| C. glabrata | ≤0.12 | 0.25 | — | ≥0.5 | ≤0.064 | — | — | >0.064 | |
| C. guilliermondii | ≤2 | 4 | — | ≥8 | — | — | — | — | |
| C. krusei | ≤0.25 | 0.5 | — | ≥1 | ≤0.064 | — | — | >0.064 | |
| C. parapsilosis | ≤2 | 4 | — | ≥8 | ≤0.002 | — | — | >4 | |
| C. tropicalis | ≤0.25 | 0.5 | — | ≥1 | ≤0.064 | — | — | >0.064 | |
| Caspofungin | C. albicans | ≤0.25 | 0.5 | — | ≥1 | — | — | — | — |
| C. glabrata | ≤0.12 | 0.25 | — | ≥0.5 | — | — | — | — | |
| C. guilliermondii | ≤2 | 4 | — | ≥8 | — | — | — | — | |
| C. krusei | ≤0.25 | 0.5 | — | ≥1 | — | — | — | — | |
| C. parapsilosis | ≤2 | 4 | — | ≥8 | — | — | — | — | |
| C. tropicalis | ≤0.25 | 0.5 | — | ≥1 | — | — | — | — | |
| Micafungin | C. albicans | ≤0.25 | 0.5 | — | ≥1 | ≤0.016 | — | — | >0.016 |
| C. glabrata | ≤0.06 | 0.12 | — | ≥0.25 | ≤0.032 | — | — | >0.032 | |
| C. guilliermondii | ≤2 | 4 | — | ≥8 | — | — | — | — | |
| C. krusei | ≤0.25 | 0.5 | — | ≥1 | — | — | — | — | |
| C. parapsilosis | ≤2 | 4 | — | ≥8 | ≤0.002 | — | — | >2 | |
| C. tropicalis | ≤0.25 | 0.5 | — | ≥1 | — | — | — | — | |
| Voriconazole | C. albicans | ≤0.12 | 0.25–0.5 | — | ≥1 | ≤0.064 | — | — | >0.25 |
| C. krusei | ≤0.5 | 1 | — | ≥2 | — | — | — | — | |
| C. parapsilosis | ≤0.12 | 0.25–0.5 | — | ≥1 | ≤0.125 | — | — | >0.25 | |
| C. tropicalis | ≤0.12 | 0.25–0.5 | — | ≥1 | ≤0.125 | — | — | >0.25 | |
| C. dubliniensis | — | — | — | — | ≤0.064 | — | — | >0.25 | |
| A. fumigatus | —b | —b | —b | —b | ≤1 | — | — | >2 | |
| Fluconazole | C. albicans | ≤2 | — | 4 | ≥8 | ≤2 | — | — | >4 |
| C. glabrata | — | — | ≤32 | ≥64 | ≤0.002 | — | — | >32 | |
| C. parapsilosis | ≤2 | — | 4 | ≥8 | ≤2 | — | — | >4 | |
| C. tropicalis | ≤2 | — | 4 | ≥8 | ≤2 | — | — | >4 | |
| Non-species specific | — | — | — | — | ≤2 | — | — | >4 | |
| Itraconazole | C. albicans | — | — | — | — | ≤0.064 | — | — | >0.064 |
| C. dubliniensis | — | — | — | — | ≤0.064 | — | — | >0.064 | |
| C. parapsilosis | — | — | — | — | ≤0.125 | — | — | >0.25 | |
| C. tropicalis | — | — | — | — | ≤0.125 | — | — | >0.25 | |
| A. flavus | — | — | — | — | ≤1 | — | — | >2 | |
| A. fumigatus | — | — | — | — | ≤1 | — | — | >2 | |
| A. nidulans | — | — | — | — | ≤1 | — | — | >2 | |
| A. terreus | — | — | — | — | ≤1 | — | — | >2 | |
| Isavuconazole | A. fumigatus | — | — | — | — | ≤1 | — | — | >1 |
| A. nidulans | — | — | — | — | ≤0.25 | — | — | >0.25 | |
| A. terreus | — | — | — | — | ≤1 | — | — | >1 | |
| Posaconazole | C. albicans | — | — | — | — | ≤0.064 | — | — | >0.064 |
| C. dubliniensis | — | — | — | — | ≤0.064 | — | — | >0.064 | |
| C. parapsilosis | — | — | — | — | ≤0.064 | — | — | >0.064 | |
| C. tropicalis | — | — | — | — | ≤0.064 | — | — | >0.064 | |
| A. fumigatus | — | — | — | — | ≤0.125 | — | — | >0.25 | |
| A. terreus | — | — | — | — | ≤0.125 | — | — | >0.25 | |
| Amphotericin B | C. albicans | — | — | — | — | ≤1 | — | — | >1 |
| C. glabrata | — | — | — | — | ≤1 | — | — | >1 | |
| C. krusei | — | — | — | — | ≤1 | — | — | >1 | |
| C. parapsilosis | — | — | — | — | ≤1 | — | — | >1 | |
| C. tropicalis | — | — | — | — | ≤1 | — | — | >1 | |
| A. fumigatus | — | — | — | — | ≤1 | — | — | >2 | |
| A. niger | — | — | — | — | ≤1 | — | — | >2 | |
a
CLSI and EUCAST breakpoints are reported in different units. Em dashes represent instances where breakpoints have not been established. S, susceptible; I, intermediate; SDD, susceptible dose dependent; R, resistant.
b
The CLSI Subcommittee on Antifungal Susceptibility Tests passed breakpoints for voriconazole against A. fumigatus in early 2019. These will be published in the next edition of the M61 document in early 2020 (8).