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Journal of Clinical Microbiology, June 1998, p. 1578-1583, Vol. 36, No. 6
Istituto di Igiene e Medicina Preventiva,
Received 4 August 1997/Returned for modification 13 September
1997/Accepted 19 February 1998
Three susceptibility testing procedures were compared to determine
fluconazole, itraconazole, and ketoconazole MICs against 47 Candida albicans strains isolated sequentially from the
oral cavities of five AIDS patients undergoing azole therapy. They included the broth microdilution method (BM), performed according to
the National Committee for Clinical Laboratory Standards' tentative standard, the agar dilution method (AD), and the Etest; the latter two
tests were performed both in Casitone agar (AD-Cas and Etest-Cas) and
in RPMI (AD-RPMI and Etest-RPMI). Twenty-four- and 48-h MICs obtained
by AD and Etest were compared with 48-h MICs obtained by BM. The MICs
of all the azoles determined by BM were usually lower than those
obtained by the other methods, mainly due to different reading
criteria. In order to assess the most appropriate way of evaluating the
agreement of MICs obtained by different methods with those produced by
the proposed reference method (BM), we used the mean differences
calculated according to Bland and Altman's method. Comparison of
fluconazole MICs obtained by BM and AD-Cas yielded a mean difference of
3, and the percentages of agreement within ±2 dilutions were 98 and
100% at 24 and 48 h, respectively. For ketoconazole and
itraconazole MICs, lower mean differences were noted, and agreement
ranged from 96 to 100%. Agreement between the AD-RPMI and BM results
was poor for all azoles, and an increase in MICs was always observed
between the 1st- and 2nd-day readings. Similarly, Etest-Cas gave better
agreement with BM than did Etest-RPMI for all the azoles. BM, AD-Cas,
and Etest-Cas each demonstrated a progressive increase in fluconazole MICs against strains isolated sequentially from a given patient, in
accordance with the decreased clinical response to fluconazole.
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.
Comparison of Three Methods for Testing Azole
Susceptibilities of Candida albicans Strains Isolated
Sequentially from Oral Cavities of AIDS Patients
IRCCS Ospedale Maggiore di
Milano,
*
Corresponding author. Mailing address: Istituto di
Igiene e Medicina Preventiva, Università degli Studi di Milano,
via F. Sforza 35, 20122 Milan, Italy. Phone: 39 2 55188373. Fax: 39 2 55191561. E-mail: viviani{at}imiucca.csi.unimi.it.
Journal of Clinical Microbiology, June 1998, p. 1578-1583, Vol. 36, No. 6
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.
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