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Journal of Clinical Microbiology, August 2002, p. 2953-2958, Vol. 40, No. 8
0095-1137/02/$04.00+0     DOI: 10.1128/JCM.40.8.2953-2958.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.

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

G. Morace,1* G. Amato,2 F. Bistoni,3 G. Fadda,4 P. Marone,5 M. T. Montagna,6 S. Oliveri,7 L. Polonelli,8 R. Rigoli,9 I. Mancuso,10 S. La Face,10 L. Masucci,4 L. Romano,4 C. Napoli,6 D. Tatò,6 M. G. Buscema,7 C. M. C. Belli,2 M. M. Piccirillo,2 S. Conti,8 S. Covan,8 F. Fanti,8 C. Cavanna,5 F. D'Alò,3 and L. Pitzurra3

Istituto di Microbiologia, Università degli Studi di Milano, Milan,1 Laboratorio di Patologia Clinica, Azienda Ospedaliera di Rilievo Nazionale, Cardarelli, Naples,2 Dipartimento di Medicina Sperimentale e Scienze Biochimiche, Sezione di Microbiologia, Università degli Studi di Perugia, Perugia,3 Istituto di Microbiologia, Università Cattolica del Sacro Cuore, Rome,4 Laboratorio di Batteriologia e Micologia, Istituto di Ricovero e Cura a Carattere Scientifico, San Matteo, Pavia,5 Dipartimento di Medicina Interna e Medicina Pubblica, Sezione di Igiene, Università degli Studi di Bari, Bari,6 Dipartimento di Scienze Microbiologiche e Scienze Ginecologiche, Sezione di Microbiologia, Università degli Studi di Catania, Catania,7 Dipartimento di Patologia e Medicina di Laboratorio, Sezione di Microbiologia, Università degli Studi di Parma, Parma,8 Laboratorio di Microbiologia, Ospedale Ca' Foncello, Treviso,9 Pfizer Italia SpA, Rome, Italy,10

Received 20 February 2002/ Returned for modification 18 April 2002/ Accepted 27 May 2002

Fluconazole susceptibility among 800 clinical Candida isolates (60% C. albicans) and two control strains (C. krusei ATCC 6258 and C. parapsilosis ATCC 22019) was tested with the NCCLS M27-A method (gold standard) and six commercial products (Candifast, disk, Etest, Fungitest, Integral System Yeasts, and Sensititre YeastOne). Results were classified as susceptible, susceptible-dose dependent, or resistant using M27-A breakpoints or, for Fungitest, Integral System Yeasts, and Candifast, as susceptible, intermediate, or resistant, according to the manufacturers' instructions. Concordance with NCCLS M27-A results was analyzed with the {chi}2 test. Intra- and interlaboratory reproducibility was also evaluated. NCCLS M27-A (90.1%), Etest (93.1%), Sensititre YeastOne (93.1%), disk (96.7%), Fungitest (92.6%), Integral System Yeasts (40.6%), and Candifast (6.0%) classified the indicated percentages of C. albicans isolates as susceptible. Among non-C. albicans strains, the percentages of susceptible isolates were as follows: NCCLS M27-A, 74.0%; Etest, 83.8%; Sensititre YeastOne, 64.1%; disk, 60.6%; Fungitest, 76.6%; Integral System Yeasts, 28.3%; and Candifast, 27.4%. All methods except Candifast and Integral System Yeasts showed good agreement with NCCLS M27-A results for both C albicans and non-C. albicans isolates. Intralaboratory reproducibility was excellent for NCCLS M27-A, Etest, Sensititre YeastOne, disk, and Fungitest (88 to 91%). Similar results emerged from the interlaboratory reproducibility evaluation. Our findings indicate that some commercial methods can be useful for fluconazole susceptibility testing of clinical Candida isolates. Those characterized by a lack of medium standardization and/or objective interpretative criteria should be avoided. Particular caution is necessary when testing is being done for clinical and epidemiological purposes.

* Corresponding author. Mailing address: Istituto di Microbiologia, Università degli Studi di Milano, Via Pascal, 36-20133 Milan, Italy. Phone: 39 02 50315065. Fax: 39 02 50315068. E-mail: giulia.morace{at}unimi.it.

Journal of Clinical Microbiology, August 2002, p. 2953-2958, Vol. 40, No. 8
0095-1137/02/$04.00+0     DOI: 10.1128/JCM.40.8.2953-2958.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.



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