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Susceptibility

Correlation between E-Test, Disk Diffusion, and Microdilution Methods for Antifungal Susceptibility Testing of Fluconazole and Voriconazole

Madonna J. Matar, Luis Ostrosky-Zeichner, Victor L. Paetznick, Jose R. Rodriguez, Enuo Chen, John H. Rex
Madonna J. Matar
Laboratory of Mycology Research, Division of Infectious Diseases, University of Texas—Houston Medical School, Houston, Texas 77030
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  • For correspondence: madonne@inco.com.lb
Luis Ostrosky-Zeichner
Laboratory of Mycology Research, Division of Infectious Diseases, University of Texas—Houston Medical School, Houston, Texas 77030
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Victor L. Paetznick
Laboratory of Mycology Research, Division of Infectious Diseases, University of Texas—Houston Medical School, Houston, Texas 77030
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Jose R. Rodriguez
Laboratory of Mycology Research, Division of Infectious Diseases, University of Texas—Houston Medical School, Houston, Texas 77030
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Enuo Chen
Laboratory of Mycology Research, Division of Infectious Diseases, University of Texas—Houston Medical School, Houston, Texas 77030
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John H. Rex
Laboratory of Mycology Research, Division of Infectious Diseases, University of Texas—Houston Medical School, Houston, Texas 77030
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DOI: 10.1128/AAC.47.5.1647-1651.2003
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Tables

  • TABLE 1.

    Susceptibilities of 400 Candida spp. to fluconazole and voriconazole as determined by three methods at two incubation times

    Species (no. of isolates tested)Time (h)MethodFluconazoleaVoriconazolea
    Range50%90%Rangea50%90%
    C. albicans (205)24MD0.125-1280.1250.250.031-160.0310.031
    ET0.125-241.520.008-0.7500.0320.047
    DD45-21332945-253430
    48MD0.125-1280.250.50.031-320.0310.06
    ET0.094->2561.530.008-640.0320.064
    DD47-NZ332945-153430
    C. parapsilosis (66)24MD0.125-640.2510.031-20.0310.125
    ET0.38->2561.560.008-20.0320.094
    DD43-NZ362645-123931
    48MD0.250-1280.540.031-40.0310.25
    ET0.38->2562160.008-640.0320.25
    DD44-NZ362245-NZ3825
    C. tropicalis (56)24MD0.125-1280.2510.031-320.0310.125
    ET0.380->2561.540.016-1.50.0640.19
    DD40-10332840-123025
    48MD0.125-1281160.031-320.1251
    ET0.750-512260.019-640.190.75
    DD38-NZ282437-NZ2418
    C. glabrata (39)24MD0.250-64480.031-20.1251
    ET2-5128320.047-20.1250.38
    DD38-NZ272035-122924
    48MD0.250-1288320.031-80.52
    ET4-51224640.094-30.381
    DD32-NZ191232-NZ2015
    C. krusei (24)24MD0.5-12816160.031-10.1250.25
    ET1.5->25648960.016-1050.190.38
    DD38-NZ181442-122823
    48MD1-12832640.031-20.50.5
    ET2-5125125120.016-120.752
    DD38-NZ0042-NZ1613
    Other species (10)24MD0.125-20.250.50.0310.0310.031
    ET0.5-20.7510.006-0.0230.0160.016
    DD45-36403844-384138
    48MD0.125-40.510.031-0.1250.0310.031
    ET0.5-4110.006-0.0230.0160.016
    DD45-36424045-384340
    • ↵ a The values are MICs (in micrograms per milliliter) for the MD and ET methods and inhibition zone diameter (in millimeters) for the DD method. The value shown is the lowest MIC that was greater than (for the MD and ET methods) or the greatest zone diameter that was less than (for the DD method) 50 or 90% of the observed values, as indicated. NZ, no zone.

  • TABLE 2.

    Percentage of paired MD and ET MICs within 2 doubling dilutions

    Time (h) of ET readingCorrelation (%) of ET and MD MICs
    FluconazoleVoriconazole
    24 h48 h24 h48 h
    2499.596.598.087.0
    4899.897.098.893.3
  • TABLE 3.

    Comparison of interpretive categories for fluconazole and rates of interpretive agreementa

    MethodIncubation time (h)CategoryFluconazole MIC50 (μg/ml) at 48 h by MDPredictive values (%)No. (%) of discrepant resultsbNo. (%) of total agreement
    SS-DDRMinorMajorVery major
    DD24S337231596.0c30 (7.5)0 (0.0)15 (3.8)355 (88.8)
    I184
    R021083.0d
    48S32951097.1c27 (6.7)4 (1.0)10 (2.5)359 (89.8)
    I5110
    R4171947.5d
    ET24S334141197.0c32 (8.0)1 (0.3)11 (2.8)356 (89.0)
    I395
    R1101354.2d
    48S3190997.3c43 (10.7)5 (1.3)9 (2.3)343 (85.8)
    I1451
    R5281936.5d
    • ↵ a S, susceptible; I, intermediate; R, resistant; S-DD, susceptible-dose dependent; MIC50, MIC at which 50% of isolates are inhibited.

    • ↵ b Minor discrepancies, susceptible-dose dependant by one method but susceptible or resistant by the other; Major discrepancies, resistant by the test method but susceptible by the reference test; very major discrepancies, susceptible by the test method but resistant by the reference test.

    • ↵ c The value shown is the percentage of the time that a result of susceptible by the agar-based method correlated with a susceptible or susceptible-dose dependent result by the reference MD method.

    • ↵ d The value shown is the percentage of the time that a result of resistant by the agar-based method correlated with a result of resistance by the reference MD method.

  • TABLE 4.

    Correlation between results of MD and DD methods for voriconazole after 24 and 48 h of incubation

    Time and disk zone diam (mm)No. of isolates for which the MD MIC (μg/ml) at the indicated times was as follows:
    24 h MD MICs48 h MD MICs
    0.0310.0620.1250.2500.51.02.0>4.0Total0.0310.0620.1250.2500.51.02.0>4.0Total
    24 h
        453333
        448888
        436666
        42111110111
        41811109110
        4017171411117
        3914115131115
        3824241731324
        37151161131116
        36222221122
        353813930611139
        3437373321137
        3327330193151130
        323321362731111236
        31132412093133120
        30173421271212263127
        296241242113112
        28772218233153118
        2741421123241212
        261141722127
        251243111213321212
        241111
        23211411114
        221113123
        2111111
        201111
        181111
        161111
        1223161416
        Total for 24 h312283115352440024839162037151213400
    48 h
        457777
        4410109110
        4314141414
        425555
        415555
        40111113111113
        3910109110
        38151161311116
        371212101112
        362424221124
        352626213226
        343939371139
        332121182121
        3229231255131
        3166516
        3024242021124
        2981943119
        281041443122214
        27516121116
        264152215
        25611119311319
        2423128111238
        235272237
        2263110111131210
        213364116
        204361312213413
        19112112
        18145111131335113
        171124314
        164610152210
        15516426
        1412333
        1312141124
        011231811518
        Total for 48 h312283115352440024839162037151213400
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Correlation between E-Test, Disk Diffusion, and Microdilution Methods for Antifungal Susceptibility Testing of Fluconazole and Voriconazole
Madonna J. Matar, Luis Ostrosky-Zeichner, Victor L. Paetznick, Jose R. Rodriguez, Enuo Chen, John H. Rex
Antimicrobial Agents and Chemotherapy May 2003, 47 (5) 1647-1651; DOI: 10.1128/AAC.47.5.1647-1651.2003

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Correlation between E-Test, Disk Diffusion, and Microdilution Methods for Antifungal Susceptibility Testing of Fluconazole and Voriconazole
Madonna J. Matar, Luis Ostrosky-Zeichner, Victor L. Paetznick, Jose R. Rodriguez, Enuo Chen, John H. Rex
Antimicrobial Agents and Chemotherapy May 2003, 47 (5) 1647-1651; DOI: 10.1128/AAC.47.5.1647-1651.2003
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KEYWORDS

antifungal agents
Candida
fluconazole
microbial sensitivity tests
Pyrimidines
triazoles

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