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Journal of Clinical Microbiology, September 2005, p. 4535-4540, Vol. 43, No. 9
0095-1137/05/$08.00+0     doi:10.1128/JCM.43.9.4535-4540.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.

Comparison of Visual 24-Hour and Spectrophotometric 48-Hour MICs to CLSI Reference Microdilution MICs of Fluconazole, Itraconazole, Posaconazole, and Voriconazole for Candida spp.: a Collaborative Study

A. Espinel-Ingroff,1* F. Barchiesi,2 M. Cuenca-Estrella,3 A. Fothergill,4 M. A. Pfaller,5 M. Rinaldi,4 J. L. Rodriguez-Tudela,3 and P. E. Verweij6

VCU Medical Center, Richmond, Virginia,1 Public Health, Ancona, Italy,2 Instituto Salud Carlos III, Majadahonda, Spain,3 University of Texas Health Science Center, San Antonio, Texas,4 University of Iowa College of Medicine, Iowa City, Iowa,5 Medical Center Nijmegen, Nijmegen, The Netherlands6

Received 27 March 2005/ Returned for modification 31 May 2005/ Accepted 13 June 2005

A multicenter (six-center) study evaluated the performance (interlaboratory reproducibility, compatibility with reference methods, and categorical agreement) of 24-h visual and 48-h spectrophotometric MICs. MICs of fluconazole, itraconazole, voriconazole, and posaconazole were compared to reference 48-h microdilution broth visual MICs (CLSI [formerly NCCLS] M27-A2 document) for 71 isolates of Candida spp. that included 10 fluconazole-resistant strains. Twenty readings (5%) were reported as showing no growth at 24 h, mostly for Candida dubliniensis and from a single center. The overall interlaboratory agreement of 24-h visual readings and 48-h spectrophotometric MICs, as well their compatibility with reference values, were excellent with the four triazoles for most of the species (93 to 99%, within 3 dilutions). The categorical agreement between the investigational reading conditions and reference values was good with fluconazole and voriconazole (93 to 97%) but lower with itraconazole (86 to 88%), due primarily to minor errors. There were only 0 to 3% very major errors with these three triazoles; the number of substantial errors (more than three dilutions) was also low (<2%) with posaconazole. These data suggest that the performance of both investigational MIC readings gives results similar to those of reference MICs. Since spectrophotometric MICs are more objective and the 24-h time period would shorten the MIC determination of azoles, the description of either of these two reading conditions in the M27-A2 document should be considered by the CLSI subcommittee in addition to or instead of the longer, less practical, and more subjective 48-h visual MIC reading.

* Corresponding author. Mailing address: VCU Medical Center Medical Mycology Research Laboratory, 1101 E. Marshall St., Sanger Hall, Room 7049, P.O. Box 980049, Richmond, VA 23298-0049. Phone: (804) 828-9711. Fax: (804) 828-3097. E-mail: avingrof{at}hsc.vcu.edu.

Journal of Clinical Microbiology, September 2005, p. 4535-4540, Vol. 43, No. 9
0095-1137/05/$08.00+0     doi:10.1128/JCM.43.9.4535-4540.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.



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