Fungal infections and antifungal resistance are increasingly recognized. Antifungal susceptibility testing remains unstandardized, and a particularly important problem is endpoint determination. In this paper we propose the yeast metabolic reduction of the tetrazolium salt 2,3-bis(2-methoxy-4-nitro-5-sulfophenyl)-5-[(phenylamino)carbonyll-2H-tetrazolium hydroxide (XTT) as a colorimetric endpoint which is quantitative and objective. Amphotericin B, fluorocytosine, and fluconazole dose-response curves were obtained, and a metabolic MIC could be determined by using precise criteria.Yeast infections are an increasingly important problem, particularly in immunocompromised patients. The recognition of antifungal resistance stresses the need for improved susceptibility testing. Unfortunately, antifungal drug susceptibility assays have been difficult to standardize (6,11,15,16,18). While considerable progress has been made, the determination of endpoints is still not satisfactory. In most assays endpoints are determined by visually grading turbidity, a subjective operation, particularly problematic when testing azole drugs for which trailing endpoints are common (4,7,9). In this paper we describe an innovative colorimetric, quantitative method of endpoint determination for susceptibility testing based on the reduction of a tetrazolium salt.Tetrazolium salts are widely used as indicators of reducing systems (2, 10). When reduced they give rise to a colored formazan crystal. Because these agents are cleaved by various dehydrogenase enzymes, active mitochondria will produce colored formazans and provide a colorimetric method to detect metabolically active cells. By using a spectrophotometer or an enzyme-linked immunosorbent assay (ELISA) plate reader, this methodology is amenable to quantitation. One tetrazolium salt, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide) (MTT), has been used for anticancer drug assays (1,13,20).Historically, formazans were water insoluble and could not easily be quantified without performing additional steps involving centrifugation of cells and removal of media, use of an organic solvent such as dimethyl sulfoxide, and occasionally sonication. Recently a new tetrazolium salt, 2,3-bis(2-methoxy-4-nitro-5-sulfophenyl)-5-[(phenylamino)carbonyl]-2H-tetrazolium hydroxide (XTT), which after reduction yields a water-soluble formazan, has been synthesized (14). XTT-based assays have also been used in a variety of eukaryotic cell drug assays (3,17,21). We describe a drug susceptibility assay for yeasts based on XTT reduction and quantitation of the resulting colored formazan solution.MATERIALS AND METHODS Organisms. Most yeast strains were clinical isolates from the microbiology laboratory of the Toronto Hospital (numbers refer to the Toronto Hospital collection number). Ad-* Corresponding author. ditional strains of Candida lusitaniae (including C. lusitaniae FR-8900) were obtained from R. Summerbell (Provincial Health Laboratory, Toronto, Canada). Organisms were maintained on Sabouraud ...