{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T16:56:44Z","timestamp":1785430604632,"version":"3.56.0"},"reference-count":44,"publisher":"American Society for Microbiology","issue":"6","license":[{"start":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:00Z","timestamp":1781049600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:00Z","timestamp":1781049600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"DOI":"10.13039\/100005564","name":"Gilead Sciences","doi-asserted-by":"publisher","award":["IN-EU-131-6577"],"award-info":[{"award-number":["IN-EU-131-6577"]}],"id":[{"id":"10.13039\/100005564","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["J Clin Microbiol"],"published-print":{"date-parts":[[2026,6,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      Sensititre YeastOne (SYO) is a widely used commercial colorimetric assay, yet its performance for\n                      <jats:italic toggle=\"yes\">C. auris<\/jats:italic>\n                      remains uncertain. We tested 113 global isolates, including 24\n                      <jats:italic toggle=\"yes\">FKS1<\/jats:italic>\n                      mutants, using SYO and the Clinical and Laboratory Standards Institute (CLSI) broth microdilution in parallel. Agreement (\u00b11 twofold dilution) and categorical agreement (CA) were assessed using Centers for Disease Control and Prevention (CDC) tentative resistance breakpoints, CLSI epidemiological cut-off values (ECVs) where available, and the SYO-specific wild-type upper limit value (WT-ULV) for amphotericin B. CLSI-SYO agreement was poor for posaconazole (18%) and amphotericin B (40%); moderate for echinocandins (42%\u201358%), voriconazole (53%), and itraconazole (65%); and very good for 5-flucytosine (85%). Minimum inhibitory concentrations (MICs) of fluconazole for most isolates were off-scale, precluding accurate estimation. Using CDC breakpoints, amphotericin B showed 31% CA (69% major errors [MaEs]), while fluconazole exhibited 95% CA (4% MaEs, 1% very major errors). Applying the SYO WT-ULV for amphotericin B corrected all discrepancies (100% CA). SYO generated higher MICs than CLSI for 5-flucytosine and azoles, with a resistance-like colorimetric phenotype resulting in high azole MICs in 8% of isolates. Up to 25% of\n                      <jats:italic toggle=\"yes\">FKS1<\/jats:italic>\n                      mutants fell below CLSI ECVs by SYO, whereas 14% of WT isolates were overcalled caspofungin-resistant due to a resistance-like colorimetric phenotype. Applying an adjusted interpretive threshold of 0.25 mg\/L for anidulafungin and micafungin, and reading growth inhibition endpoints for caspofungin, eliminated the corresponding errors. SYO reliably detects fluconazole and amphotericin B resistance (using the SYO-specific WT-ULV) but frequently misclassifies echinocandin resistance in\n                      <jats:italic toggle=\"yes\">C. auris<\/jats:italic>\n                      , particularly for caspofungin and\n                      <jats:italic toggle=\"yes\">FKS1<\/jats:italic>\n                      mutants, underscoring the need for careful interpretation and potential method-specific interpretive thresholds.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>IMPORTANCE<\/jats:title>\n                    <jats:p>\n                      Accurate antifungal susceptibility testing is critical for guiding antifungal therapy and informing infection prevention and antifungal stewardship strategies for\n                      <jats:italic toggle=\"yes\">Candida<\/jats:italic>\n                      (\n                      <jats:italic toggle=\"yes\">Candidozyma<\/jats:italic>\n                      )\n                      <jats:italic toggle=\"yes\">auris<\/jats:italic>\n                      . As Sensititre YeastOne (SYO) is a widely used commercial colorimetric assay for antifugnal susceptibility testing of\n                      <jats:italic toggle=\"yes\">Candida<\/jats:italic>\n                      spp., its performance for\n                      <jats:italic toggle=\"yes\">C. auris<\/jats:italic>\n                      was evaluated in 113 global isolates, including 24\n                      <jats:italic toggle=\"yes\">FKS1<\/jats:italic>\n                      mutants. SYO reliably detected fluconazole resistance in\n                      <jats:italic toggle=\"yes\">C. auris<\/jats:italic>\n                      at the CDC breakpoint of \u226532 mg\/L, while detection of amphotericin B resistance required the SYO-specific wild-type (WT) upper limit value of 8 mg\/L. Up to one-quarter of\n                      <jats:italic toggle=\"yes\">FKS1<\/jats:italic>\n                      mutants were misclassified as WT, whereas caspofungin resistance was overestimaed in 14% of WT isolates using the CLSI epidemiological cutoff values 1 mg\/L for anidulafungin, 0.5 mg\/L for micafungin and 0.5 mg\/L for caspofungin. Caspofungin should not be used as a standalone marker of echinocandin resistance, while anidulafungin and micafungin consistently detected\n                      <jats:italic toggle=\"yes\">FKS1<\/jats:italic>\n                      mutants using the adjusted interpretive threshold of 0.25 mg\/L.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1128\/jcm.00130-26","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T13:11:16Z","timestamp":1778764276000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of Sensititre YeastOne for antifungal susceptibility testing of\n                    <i>Candida (Candidozyma) auris<\/i>\n                    : misclassification of\n                    <i>FKS1<\/i>\n                    mutants and overestimation of caspofungin resistance in a global collection of isolates"],"prefix":"10.1128","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5924-1007","authenticated-orcid":true,"given":"Maria","family":"Siopi","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04gnjpq42","id-type":"ROR","asserted-by":"publisher"}],"name":"Clinical Microbiology Laboratory, \"Attikon\" University General Hospital, Medical School, National and Kapodistrian University of Athens","place":["Athens, Greece"]},{"name":"Molecular Microbiology and Immunology Laboratory, Department of Biomedical Sciences, University of West Attica","place":["Athens, Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sevasti","family":"Leventaki","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04gnjpq42","id-type":"ROR","asserted-by":"publisher"}],"name":"Clinical Microbiology Laboratory, \"Attikon\" University General Hospital, Medical School, National and Kapodistrian University of Athens","place":["Athens, Greece"]},{"name":"Molecular Microbiology and Immunology Laboratory, Department of Biomedical Sciences, University of West Attica","place":["Athens, Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioannis","family":"Pachoulis","sequence":"additional","affiliation":[{"name":"Molecular Microbiology and Immunology Laboratory, Department of Biomedical Sciences, University of West Attica","place":["Athens, Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aikaterini","family":"Rentoumi","sequence":"additional","affiliation":[{"name":"Molecular Microbiology and Immunology Laboratory, Department of Biomedical Sciences, University of West Attica","place":["Athens, Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikiforos","family":"Argyris","sequence":"additional","affiliation":[{"name":"Molecular Microbiology and Immunology Laboratory, Department of Biomedical Sciences, University of West Attica","place":["Athens, Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bram","family":"Spruijtenburg","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology and \u0399mmunology, Canisius-Wilhelmina Hospital (CWZ)\/Dicoon","place":["Nijmegen, the Netherlands"]},{"name":"Radboudumc-CWZ Center of Expertise for Mycology","place":["Nijmegen, the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eelco F. 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