{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,22]],"date-time":"2026-02-22T04:21:56Z","timestamp":1771734116870,"version":"3.50.1"},"reference-count":55,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T00:00:00Z","timestamp":1753833600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>Invasive infections with rare yeasts are increasing worldwide and are associated with higher mortality rates due to their resistance to antifungal drugs. Accurate antifungal susceptibility testing (AFST) is crucial for proper management of rare yeast infections. We performed AFST of 74 Candida kefyr isolates by Etest, EUCAST-based MICRONAUT-AM assay (MCN-AM) and reference Clinical and Laboratory Standards Institute broth microdilution method (CLSI). Essential agreement (EA, \u00b11 two-fold dilution), categorical agreement (CA), major errors (MEs) and very-major errors (VmEs) were determined using epidemiological cut-off values of \u22641.0 \u00b5g\/mL, \u22640.03 \u00b5g\/mL, \u22640.5 \u00b5g\/mL and \u22641 \u00b5g\/mL, defining wild-type isolates for fluconazole, voriconazole, micafungin and amphotericin B (AMB), respectively. Results for AMB susceptibility were correlated with ERG2\/ERG3 mutations and total-cell sterols. CA of \u226597% was recorded between any two methods while EA varied between 72 and 82%, 87 and 92%, and 49 and 76% for fluconazole, voriconazole and micafungin, respectively. For AMB, CAs between CLSI and Etest; CLSI and MCN-AM; MCN-AM and Etest were 95% (4 ME, 0 VmE), 96% (3 ME, 0 VmE) and 99%, respectively, while EA varied from 32% to 69%. Non-synonymous ERG2\/ERG3 mutations and no ergosterol were found in seven of eight isolates of non-wild types for AMB by Etest. Our data show that Etest, CLSI and MCN-AM methods are suitable for AFST of C. kefyr for fluconazole, voriconazole and micafungin. Excellent CAs for AMB between Etest and MCN-AM with concordant sterol profiles but not with CLSI suggest that Etest is also an excellent alternative for the detection of C. kefyr isolates with reduced susceptibility to AMB.<\/jats:p>","DOI":"10.3390\/jof11080570","type":"journal-article","created":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T14:29:02Z","timestamp":1753885742000},"page":"570","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Head-to-Head Comparison of Etest, MICRONAUT-AM EUCAST and Reference Broth Microdilution-Based CLSI Results for Candida kefyr Antifungal Susceptibility Testing: Implications for Detection of Reduced Susceptibility to Amphotericin B"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3270-055X","authenticated-orcid":false,"given":"Mohammad","family":"Asadzadeh","sequence":"first","affiliation":[{"name":"Department of Microbiology, Faculty of Medicine, Kuwait University, Jabriya 46300, Kuwait"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3492-4781","authenticated-orcid":false,"given":"Suhail","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Medicine, Kuwait University, Jabriya 46300, Kuwait"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3253-6080","authenticated-orcid":false,"given":"Jacques F.","family":"Meis","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, Radboud University Medical Center, 6525 Nijmegen, The Netherlands"},{"name":"Center of Expertise in Mycology Radboudumc\/Canisius Wilhelmina Hospital, 6532 Nijmegen, The Netherlands"},{"name":"Department I of Internal Medicine and Excellence Center for Medical Mycology, Faculty of Medicine, University Hospital Cologne, 50937 Cologne, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3855-4194","authenticated-orcid":false,"given":"Josie E.","family":"Parker","sequence":"additional","affiliation":[{"name":"Molecular Biosciences Division, School of Biosciences, Cardiff University, Cardiff CF10 3AT, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4501-5316","authenticated-orcid":false,"given":"Wadha","family":"Alfouzan","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Medicine, Kuwait University, Jabriya 46300, Kuwait"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"165rv13","DOI":"10.1126\/scitranslmed.3004404","article-title":"Hidden killers: Human fungal infections","volume":"4","author":"Brown","year":"2012","journal-title":"Sci Transl. 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