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Journal of Clinical Microbiology, March 2007, p. 698-706, Vol. 45, No. 3
0095-1137/07/$08.00+0     doi:10.1128/JCM.01840-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.

Comparative Evaluation of Etest and Sensititre YeastOne Panels against the Clinical and Laboratory Standards Institute M27-A2 Reference Broth Microdilution Method for Testing Candida Susceptibility to Seven Antifungal Agents{triangledown}

Barbara D. Alexander,1* Terry C. Byrne,2 Kelly L. Smith,1 Kimberly E. Hanson,1 Kevin J. Anstrom,3 John R. Perfect,1 and L. Barth Reller1,2

Division of Infectious Diseases and International Health, Department of Medicine,1 Clinical Microbiology Laboratory, Department of Pathology,2 Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina3

Received 5 September 2006/ Returned for modification 17 October 2006/ Accepted 21 December 2006

To assess their utility for antifungal susceptibility testing in our clinical laboratory, the Etest and Sensititre methods were compared with the Clinical and Laboratory Standards Institute (CLSI) M27-A2 reference broth microdilution method. Fluconazole (FL), itraconazole (I), voriconazole (V), posaconazole (P), flucytosine (FC), caspofungin (C), and amphotericin B (A) were tested with 212 Candida isolates. Reference MICs were determined after 48 h of incubation, and Etest and Sensititre MICs were determined after 24 h and 48 h of incubation. Overall, excellent essential agreement (EA) between the reference and test methods was observed for Etest (95%) and Sensititre (91%). Etest showed an ≥92% EA for MICs for all drugs tested; Sensititre showed a ≥92% EA for MICs for I, FC, A, and C but 82% for FL and 85% for V. The overall categorical agreement (CA) was 90% for Etest and 88% for Sensititre; minor errors accounted for the majority of all categorical errors for both systems. Categorical agreement was lowest for Candida glabrata and Candida tropicalis with both test systems. Etest and Sensititre provided better CA at 24 h compared to 48 h for C. glabrata; however, CA for C. glabrata was <80% for FL with both test systems despite MIC determination at 24 h. Agreement between technologists for both methods was ≥98% for each agent against all organisms tested. Overall, Etest and Sensititre methods compared favorably with the CLSI reference method for determining the susceptibility of Candida. However, further evaluation of their performance for determining the MICs of azoles, particularly for C. glabrata, is warranted.

* Corresponding author. Mailing address: Division of Infectious Diseases and International Health, Box 3035, Duke University Medical Center, Durham, NC 27710. Phone: (919) 668-0789. Fax: (919) 684-8519. E-mail: alexa011{at}mc.duke.edu.

{triangledown} Published ahead of print on 3 January 2007.

Journal of Clinical Microbiology, March 2007, p. 698-706, Vol. 45, No. 3
0095-1137/07/$08.00+0     doi:10.1128/JCM.01840-06
Copyright © 2007, American Society for Microbiology. All Rights Reserved.



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