A total of 750 clinical yeast isolates were evaluated by two identification systems, VITEK 2 and RapID Yeast Plus, using sequence analysis of the rRNA gene internal transcribed spacer regions as the reference method. The VITEK 2 and RapID systems correctly identified 737 (98.2%) and 716 (95.5%) isolates, respectively.Although Candida species, including the pathogenic Candida albicans, remain the yeast species most commonly encountered in a clinical microbiology laboratory, a variety of other yeasts are recovered from patients with well-documented infections. Accurate identification of these species is clinically important, as certain yeast species are associated with specific diseases (11,22). In addition, yeast species can differ greatly in their relative virulence levels (22) as well as their susceptibilities to antifungal agents (19). While there is an increasing move toward molecular biology-based diagnostic approaches (1), identification of clinical yeast isolates is still typically performed by biochemical, morphological, and physiological tests (8). These phenotypic systems often produce results that may not be accurate, so their performance must be reassessed to enable users to have a reliable system for yeast identification. In this study, we compared the VITEK 2 (bioMérieux VITEK, Marcy l'Etoile, France) and RapID Yeast Plus (Remel Inc., Lenexa, KS) systems, with sequence analysis of the rRNA gene internal transcribed spacer (ITS) regions used as the reference method, for the identification of medically important yeasts typically found in a large clinical microbiology laboratory.A total of 750 yeast isolates, representing 24 species of six genera, were studied. Isolates were obtained from clinical samples (oral, vaginal, anorectal, urine, stool, blood, central Candida krusei ATCC 6258 were used as quality control strains. Isolates were grown on Sabouraud dextrose agar (Kima, Padua, Italy) for 48 h at 30°C prior to being tested. Each isolate was simultaneously tested with the VITEK 2 system (version 4.02), using the new colorimetric YST card (BioMérieux), and with the RapID Yeast Plus system (version 1.95), according to the instructions of their respective manufacturers, and the results were compared. In cases of discrepant results, both methods were repeated and the results for the second runs were accepted as the final results. In cases of identification with low discrimination (see below), additional tests (e.g., microscopic morphology on cornmeal-Tween 80 agar or growth at 42 to 45°C) were carried out (3). ITS sequence analysis was performed on all 750 isolates and used as the reference system. Thus, purified genomic DNA was obtained from each yeast isolate, using an EZ1 DNA tissue kit (QIAGEN, Milan, Italy) and a BioRobot EZ1 workstation (QIAGEN) in accordance with the manufacturer's instructions. This included a preliminary step in which yeast colonies were resuspended in 190 l of buffer G2, 10 l of lyticase (25 units/l) was added to each cell sample, and the resulting mixture was incubated at 3...