Multicenter Comparative Evaluation of Six Commercial Systems and the National Committee for Clinical Laboratory Standards M27-A Broth Microdilution Method for Fluconazole Susceptibility Testing of
            <i>Candida</i>
            Species

Morace, Giulia; Amato, Gerardino; Bistoni, Francesco; Fadda, Giovanni; Marone, Piero; Montagna, Maria Teresa; Oliveri, Salvatore Massimo; Polonelli, Luciano; Rigoli, Roberto; Mancuso, I.; Face, S. La; Masucci, Luca; Romano, Lucio; Napoli, Christian; Tatò, D.; Buscema, Massimo; Belli, C. M C; Piccirillo, M. M.; Conti, Stefania; Covan, Silvia; Fanti, Franco; Cavanna, C.; D’Alo’, Francesco; Pitzurra, Lucia

doi:10.1128/jcm.40.8.2953-2958.2002

Cited by 66 publications

(69 citation statements)

References 17 publications

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“…The results of this study confirm and extend those of previous reports regarding the ability of Etest to generate fluconazole and voriconazole MIC data for the less common species of Candida (1,6,9,11,14). Previously, agreement was demonstrated between Etest (by using RPG) and the reference BMD method of 94% for fluconazole and 98% for voriconazole in studies where the vast majority of isolates were the more common species of Candida (11,14).…”

Section: Resultssupporting

confidence: 80%

“…against a variety of antifungal agents, including fluconazole and voriconazole (1,3,9,11,12,14,16,17,22,24). The species of Candida tested in these studies generally represent those most commonly isolated from clinical sources and are dominated by Candida albicans, C. glabrata, C. parapsilosis, and C. tropicalis, which account for 95 to 97% of all clinical isolates of Candida spp.…”

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confidence: 99%

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Evaluation of Etest Method for Determining Fluconazole and Voriconazole MICs for 279 Clinical Isolates of Candida Species Infrequently Isolated from Blood

Maxwell¹,

Messer²,

Hollis³

et al. 2003

J Clin Microbiol

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The performance of Etest in fluconazole and voriconazole testing of 279 isolates of uncommon Candida spp. was assessed in comparison with the National Committee for Clinical Laboratory Standards (NCCLS)-approved standard broth microdilution (BMD) method. The NCCLS method employed RPMI 1640 broth medium, and MICs were read after incubation for 48 h at 35°C. Etest MICs were determined with RPMI agar containing 2% glucose and were read after incubation for 48 h at 35°C. The isolates include Candida krusei, C. lusitaniae, C. guilliermondii, C. kefyr, C. rugosa, C. lipolytica, C. pelliculosa, C. dubliniensis, C. famata, C. zeylanoides, C. inconspicua, and C. norvegensis. Overall agreement between Etest and BMD MICs was 96% for fluconazole and 95% for voriconazole. Where a discrepancy was observed between Etest and the reference method, the Etest tended to give lower values with both fluconazole and voriconazole. The Etest method using RPMI agar appears to be a useful method for determining fluconazole and voriconazole susceptibilities of uncommon species of Candida.The Etest stable agar gradient MIC method (AB BIODISK, Solna, Sweden) has been shown to be useful in testing Candida spp. against a variety of antifungal agents, including fluconazole and voriconazole (1,3,9,11,12,14,16,17,22,24). The species of Candida tested in these studies generally represent those most commonly isolated from clinical sources and are dominated by Candida albicans, C. glabrata, C. parapsilosis, and C. tropicalis, which account for 95 to 97% of all clinical isolates of Candida spp. (8,13,15,18). Thus, although Etest has been validated for the four most common species of Candida, the evidence supporting its use in testing the less common species is lacking.Among the approximately 17 species of Candida reported to cause bloodstream infections (BSI) (8), 12 or 13 of these species account for less than 5% of all Candida BSI (19). These rare species include among others, C. krusei, C. lusitaniae, C. guilliermondii, C. kefyr, C. rugosa, and C. dubliniensis, several of which may pose problems with antifungal resistance and nosocomial spread (4,5,7,23,26). Although less common than C. albicans, C. glabrata, C. parapsilosis, and C. tropicalis, these species may pose difficult management problems for individual patients, which may benefit from the application of antifungal susceptibility testing (21). Given the use of Etest for antifungal susceptibility testing of the common Candida spp. causing BSI, it is reasonable to validate its use for testing systemically active agents, such as fluconazole and voriconazole, against these less common species as well.The purpose of the present study is to expand the Etest database for fluconazole and voriconazole by testing an international collection of 279 clinical BSI isolates of 12 uncommon species of Candida obtained from 68 different locations in 26 nations. The fluconazole and voriconazole MICs determined by Etest are compared to MICs determined by the National Committee for Clinical Laboratory Standard...

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Section: Resultssupporting

confidence: 80%

mentioning

confidence: 99%

Evaluation of Etest Method for Determining Fluconazole and Voriconazole MICs for 279 Clinical Isolates of Candida Species Infrequently Isolated from Blood

Maxwell¹,

Messer²,

Hollis³

et al. 2003

J Clin Microbiol

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“…The facts that both fluconazole and voriconazole are in the same triazole class as posaconazole, have Clinical and Laboratory Standards Institute (CLSI)-approved MIC interpretive breakpoints (32,33), and are available on some commercially available MIC panels (10,19,29,34,38) suggest that one or both of these agents may be useful as a surrogate marker for posaconazole susceptibility.…”

mentioning

confidence: 99%

Selection of a Surrogate Agent (Fluconazole or Voriconazole) for Initial Susceptibility Testing of Posaconazole against Candida spp.: Results from a Global Antifungal Surveillance Program

Pfaller¹,

Messer²,

Boyken³

et al. 2008

J Clin Microbiol

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There are currently no FDA-approved broth microdilution antifungal susceptibility testing products or interpretive breakpoints for susceptibility testing of the new triazole posaconazole. Fluconazole and voriconazole are in the same triazole class as posaconazole, have CLSI-approved interpretive MIC breakpoints, and are available on some commercially available MIC panels. We investigated whether one or both of these agents may be useful as a surrogate marker for posaconazole susceptibility. Fluconazole, voriconazole, and posaconazole MIC results for 10,807 isolates of Candida spp. were analyzed to validate a potential surrogate marker for posaconazole activity against indicated species. For illustrative purposes, we applied the voriconazole MIC breakpoints to posaconazole (susceptible, <1 g/ml; susceptible dose dependent, 2 g/ml; resistant, >4 g/ml) and compared these MIC results and categorical interpretations with those of fluconazole and voriconazole by using regression statistics and categorical agreement. For all 10,807 isolates, the absolute categorical agreement was 91.1% (0.1% very major errors [VME], 1.2% major errors [ME], and 7.6% minor errors [M]) using fluconazole as the surrogate marker and 97.7% (0.3% VME 0.1% ME, and 1.9% M) using voriconazole as the surrogate. The results with fluconazole improved to a categorical agreement of 93.7% (0.1% VME, 0.2% ME, and 6.0% M) when results for Candida krusei (not indicated for fluconazole testing) were omitted. Either fluconazole or voriconazole MIC results may serve as surrogate markers to predict the susceptibility of Candida spp. to posaconazole.

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“…The performance of the various commercially available antifungal testing systems has been variable (8,10,16,17), and prior to the present study only two, the Sensititre YeastOne System (Trek, Cleveland, OH) and the Etest (AB BIODISK, Solna Sweden), have been approved by the U.S. Food and Drug Administration (FDA) for in vitro susceptibility testing of fluconazole against Candida spp. (21, 26).…”

mentioning

confidence: 99%

Multicenter Comparison of the VITEK 2 Yeast Susceptibility Test with the CLSI Broth Microdilution Reference Method for Testing Fluconazole against Candida spp

et al. 2007

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Standardized broth microdilution (BMD) susceptibility testing of fluconazole against Candida spp. has been available since 1997 (19,21,30). The establishment of a panel of quality control (QC) strains and validated, clinically useful interpretive breakpoints (19, 20,27,30,32) has allowed this method to be used worldwide (3, 6-8, 12, 17, 21, 33).The Clinical and Laboratory Standards Institute (CLSI; formerly National Committee for Clinical Laboratory Standards [NCCLS]) BMD method for testing fluconazole has served as a touchstone for the development of both broth-and agarbased procedures designed to provide simple, flexible, and commercially available alternative susceptibility testing methods for use in the clinical laboratory (8-12, 16, 17, 21, 23-25). The performance of the various commercially available antifungal testing systems has been variable (8,10,16,17), and prior to the present study only two, the Sensititre YeastOne System (Trek, Cleveland, OH) and the Etest (AB BIODISK, Solna Sweden), have been approved by the U.S. Food and Drug Administration (FDA) for in vitro susceptibility testing of fluconazole against Candida spp. (21, 26).Although spectrophotometric reading of BMD MIC endpoints has been shown to be valid and feasible for use in the clinical laboratory (11,12,16, 20,21), this approach has not been incorporated into a commercially available testing method. Recently, bioMerieux (Hazelwood, MO) has developed a yeast susceptibility test that determines growth spectrophotometrically and allows fully automated antifungal susceptibility testing of fluconazole against Candida using the VITEK 2 microbiology system. The fully automated VITEK 2 system allows for the standardization of all of the critical parameters known for antifungal susceptibility testing: inoculum preparation, filling of the device, duration and temperature of incubation, and endpoint determination. The yeast susceptibility test, coupled with the rapid and accurate yeast identification capabilities already available on the VITEK 2 (4), would allow clinical laboratories to perform both yeast identification and antifungal susceptibility testing using a fully automated and completely standardized format. Preliminary studies by Zambardi et al. (G. Zambardi et al., Abstr. 45th Intersci. Conf. Antimicrob. Agents Chemother., abstr. M-1619, 2005 have shown both essential and categorical agreements of Ն90% in a comparison of VITEK 2 MICs with reference BMD MICs for fluconazole and Candida spp. The VITEK 2 results were available in Յ15 h compared to 48 h for the reference BMD method.The purpose of the present study was to validate the performance of the VITEK 2 yeast susceptibility test with fluconazole against a broad range of Candida spp. in three independent laboratories. The VITEK 2 results were compared to those from a frozen reference BMD panel performed according to CLSI guidelines. It is notable that after the completion of the present study the VITEK 2 yeast susceptibility test for fluconazole was approved for clinical use by the U....

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Multicenter Comparative Evaluation of Six Commercial Systems and the National Committee for Clinical Laboratory Standards M27-A Broth Microdilution Method for Fluconazole Susceptibility Testing of Candida Species

Cited by 66 publications

References 17 publications

Evaluation of Etest Method for Determining Fluconazole and Voriconazole MICs for 279 Clinical Isolates of Candida Species Infrequently Isolated from Blood

Evaluation of Etest Method for Determining Fluconazole and Voriconazole MICs for 279 Clinical Isolates of Candida Species Infrequently Isolated from Blood

Selection of a Surrogate Agent (Fluconazole or Voriconazole) for Initial Susceptibility Testing of Posaconazole against Candida spp.: Results from a Global Antifungal Surveillance Program

Multicenter Comparison of the VITEK 2 Yeast Susceptibility Test with the CLSI Broth Microdilution Reference Method for Testing Fluconazole against Candida spp

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