| Clinical setting | Recommendation |
| Routine | - Species level identification of all Candida isolates from deep sites (eg, blood, normally sterile fluids, tissues, abscesses).
- Species level identification of Aspergillus, genus level for all other molds.
- Species level (if possible) identification of non-candidal yeast isolates from deep sites (eg, blood, normally sterile fluids, tissues, abscesses).
- Selection of therapy is generally based on published consensus guidelines and review of survey data on the organism-drug combination in question.
- Routine susceptibility testing of fluconazole, voriconazole, and an echinocandin against all species of Candida from deep sites (eg, blood, normally sterile fluids, tissues and abscesses).
- Susceptibility of Candida spp other than C. glabrata to echinocandins may be assumed unless initial response is suboptimal. Susceptibility testing of isolates to an echinocandin should be considered if there is a prior history of exposure to this class of agents.
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| Mucosal candidiasis | - Susceptibility testing may be useful for patients unresponsive to therapy.
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| Invasive disease with clinical failure of initial therapy | - Consider susceptibility testing.
- Candida spp: amphotericin B, flucytosine, fluconazole, voriconazole, echinocandins
- C. neoformans: fluconazole, amphotericin B, flucytosine
- Aspergillus species: amphotericin B, posaconazole, itraconazole, voriconazole, isavuconazole
- Consultation with an experienced microbiologist recommended.
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| Infection with species with high rates of intrinsic or acquired resistance | - Susceptibility testing not necessary when intrinsic resistance is known.
- A. terreus: amphotericin B
- C. krusei: fluconazole, flucytosine
- Cryptococcus and Trichosporon: echinocandins
- Rhodotorula: azoles, echinocandins
- Mucorales: voriconazole, echinocandins
- For species with significant rates of acquired resistance, monitor closely for signs of failure and perform susceptibility testing as needed.
- C. glabrata: fluconazole, voriconazole, amphotericin B, echinocandins
- C. auris: fluconazole, voriconazole, amphotericin B, echinocandins
- C. krusei: amphotericin B
- C. lusitaniae: amphotericin B
- C. rugosa: amphotericin B, fluconazole
- Candida spp: flucytosine, when used for endocarditis
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| Unusual organisms | - Susceptibility testing may be helpful when treating patients infected with unusual organisms for which susceptibility patterns have not been well established or are unpredictable.
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| Mold infections | - Species level identification of Aspergillus, genus level for all other molds.
- Routine susceptibility testing not recommended.
- Susceptibility of Aspergillus species to itraconazole, voriconazole, isavuconazole, and posaconazole may help to determine cross-resistance.
- Clinical interpretive criteria have not been established for any agents.
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