title: Disk diffusion test and E-test with enriched Mueller-Hinton agar for determining susceptibility of Candida species to voriconazole and fluconazole.
abstract: OBJECTIVE
  A simplified antifungal disk diffusion test using Mueller-Hinton agar containing 2% glucose and methylene blue 5 microg/mL (GM-MH, Clinical and Laboratory Standards Institute [CLSI] M44-A) has proved to correlate well with the standard reference test. A new azole, voriconazole, has recently been approved for clinical therapy in Taiwan. This study investigated the reliability of the disk diffusion test with GM-MH agar and compared the results with those of the E-test using GM-MH agar to determine the voriconazole and fluconazole susceptibility of Candida isolates.
  
  
  METHODS
  The antimicrobial susceptibility of Candida isolates were evaluated by E-test and disk diffusion test in accordance with the guidelines of the CLSI, and compared with the reference antifungal macrodilution susceptibility test (CLSI M27-A).
  
  
  RESULTS
  The antifungal disk diffusion test and the E-test using GM-MH agar plate provided a sufficiently accurate, time-efficient, and cost-effective way to determine the susceptibility of 182 Candida spp. to voriconazole and fluconazole. There was a high correlation between the test results of the E-test using the GM-MH agar plate and those obtained by the reference antifungal macrodilution susceptibility test (CLSI M27-A). The results of the E-test and those of the 1-microg voriconazole disk diffusion test on the GM-MH agar plate at 24 h had a high correlation. All the minimal inhibitory concentrations of voriconazole for all Candida spp. were <8 microg/mL. The positive predictive value of the susceptible disk test of voriconazole on the GM-MH agar plate was 100% at 24 h for C. albicans and other Candida spp.
  
  
  CONCLUSIONS
  The disk diffusion test and the E-test using the GM-MH agar plate can be performed quickly, simply, and cost-effectively, and are practicable methods for the initial testing of the susceptibility of Candida spp. to voriconazole and fluconazole.
authors: Division of Infectious Diseases, Chang Gung Memorial Hospital, Keelung, Taiwan. lee.sch@msa.hinet.net
authors: Sai-Cheong
authors: SC
authors: Lee
authors: Hsiu-Jung
authors: HJ
authors: Lo
authors: Chang-Phone
authors: CP
authors: Fung
authors: Ning
authors: N
authors: Lee
authors: Lai-Chu
authors: LC
authors: See
mesh_terms: D000935:Antifungal Agents / Q000494:pharmacology*; D002175:Candida / Q000187:drug effects* / Q000302:isolation & purification; D002177:Candidiasis / Q000382:microbiology; D003470:Culture Media / Q000737:chemistry*; D015725:Fluconazole / Q000494:pharmacology*; D006801:Humans; D008826:Microbial Sensitivity Tests / Q000191:economics / Q000379:methods; D011743:Pyrimidines / Q000494:pharmacology*; D013624:Taiwan; D014230:Triazoles / Q000494:pharmacology*; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D003470:Culture Media; D011743:Pyrimidines; D014230:Triazoles; D015725:Fluconazole; D065819:Voriconazole