Ordering Recommendation

Use to determine in vitro susceptibility of fungal organisms to antifungal agents.

New York DOH Approval Status

This test is New York state approved.

Specimen Required

Patient Preparation
Collect

Actively growing mold or yeast isolate in pure culture.

Specimen Preparation

Transport sealed container with pure culture on agar slant. Place each specimen in individually sealed bag.

Storage/Transport Temperature

Room temperature

Unacceptable Conditions

Mixed cultures or nonviable organisms

Remarks

Isolate identification and specimen source required.

Stability

Ambient: 2 weeks; Refrigerated: 2 weeks; Frozen: Unacceptable

Methodology

Broth Microdilution

Performed

Sun-Sat

Reported

2-21 days

Reference Interval

Susceptible, intermediate, SDD (susceptible dose dependent), or resistant
MICs (minimum inhibitory concentrations) interpretations are based on current CLSI guidelines.
MECs (minimum effective concentrations) without interpretation are reported for select mold species only.

Interpretive Data

Refer to report.

Compliance Category

Depends on Specimen/Source/Method

Note

The following antifungal agents are tested (selective reporting by organism and body site):

Yeast (Candida species and yeast formerly known as Candida such as N. glabrata, etc.): Amphotericin B, anidulafungin, caspofungin, fluconazole, isavuconazole, itraconazole, micafungin, posaconazole, rezafungin, and voriconazole. 5-fluorocytosine and ketoconazole are tested by request only at an additional charge.

Yeast (non-Candida species): Amphotericin B, anidulafungin, caspofungin, fluconazole, 5-fluorocytosine, itraconazole, ketoconazole, micafungin, posaconazole, and voriconazole.

Mold: Amphotericin B, anidulafungin, caspofungin, isavuconazole, itraconazole, ketoconazole, micafungin, posaconazole, and voriconazole.

Requests for drug testing not performed at ARUP will be referred to the Fungus Testing Laboratory at the University of Texas Health Science Center at an additional charge.

Not all antifungal agents attain adequate concentration in all body sites:

*Vitreal Penetration: Systemic administration of echinocandins is not recommended for ocular infections because it has minimal tissue penetration. Consult ophthalmology, pharmacy, or infectious disease service for guidance.
*CSF Penetration: The echinocandins have suboptimal penetration in CSF and CNS tissues. Consult the pharmacy and/or infectious disease service for additional guidance.
*Urine Penetration: ONLY fluconazole and 5-fluorocytosine (note that the lack of detectable urine concentrations does not necessarily preclude use of other drugs when the infection involves the renal parenchyma). Lipid formulations of amphotericin B do not achieve adequate urine concentrations and should not be used to treat UTIs.

5-fluorocytosine: 5-FC should not be used as monotherapy for severe Candida infection because resistance can develop rapidly. It should be used rarely in neonates.

Susceptibility testing of some molds is not clinically relevant (i.e., Penicillium species or Cladosporium species).

Susceptibility testing for dermatophytes and dimorphic fungi is not performed at ARUP. If requested, isolates will be sent to the Fungus Testing Laboratory at the University of Texas Health Science Center. Specify agents to be tested on the susceptibility test requisition form.

Testing is not performed on isolates from environmental sources.

An additional processing fee will be billed for all organisms not submitted in pure culture, as indicated in the specimen requirements.

If species identification is not provided or if incorrect identification is provided, identification will be performed at ARUP. Additional charges apply.

Hotline History

N/A

CPT Codes

87186

Components

Component Test Code* Component Chart Name LOINC
2009257 Susceptibility, Fungal (Yeasts & Molds) 29577-4
* Component test codes cannot be used to order tests. The information provided here is not sufficient for interface builds; for a complete test mix, please click the sidebar link to access the Interface Map.

Aliases

  • Fungal MIC
  • Fungal Susceptibility
  • Mold MEC
  • Mold MIC
  • Yeast MIC
Antimicrobial Susceptibility - Fungal (Yeasts and Molds)