title: Susceptibility tests of oropharyngeal Candida albicans from egyptian patients to fluconazole determined by three methods.
abstract: Candida albicans frequently cause oropharyngeal candidiasis in immunocompromised patients. As some of these isolates show resistance against azoles, the clinician is wary of initiating therapy with fluconazole (FZ) until a final susceptibility report is generated. We aimed to evaluate the efficacy of rapid flow cytometry (FCM) and disc diffusion (DD) methods in comparison to reference microdilution (MD) of Clinical and Laboratory Standards Institute (CLSI) method for FZ. Thirty seven Candida albicans isolates were tested by the three methods. By both MD and FCM, 26/37 (70.3%) were sensitive with minimal inhibitory concentration (MIC) ≤ 8μg/ml, 5/37 (13.5%) were susceptible dose dependant (S-DD) with MIC 16-32 μg/ml and 6/37 (16.2%) were resistant with MIC ≥64μg/ml. More than 92% of isolates susceptible to FZ by the MD were susceptible by the DD methods with good agreement (81.08%, P = 0.000). However, 4/5 isolates diagnosed as S-DD by MD were resistant by DD. Interestingly, the MIC by FCM at 4 h showed excellent agreement (95.59%, P = 0.000) to that obtained by MD method at 24 h. Overall, FCM antifungal susceptibility testing provided rapid, reproducible results that are valuable alternative to MD. The DD test is recommended as a simple and reliable screening test for the detection of susceptible Candida albicans isolates to FZ.
authors.affiliation: Department of Clinical Pathology, Faculty of Medicine, Mansoura University , Egypt.
authors.forename: Noha
authors.initials: N
authors.lastname: El-Mashad
authors.forename: Mona F
authors.initials: MF
authors.lastname: Foad
authors.forename: Niveen
authors.initials: N
authors.lastname: Saudy
authors.forename: Dalia A
authors.initials: DA
authors.lastname: Salem
keywords: CLSI; Disk diffusion; NCCLS; flowcytometry; fluconazole; malignant patients
references.citation: J Clin Microbiol. 1997 Sep;35(9):2320-4
references.pmid: 9276410
references.citation: J Clin Microbiol. 2007 Mar;45(3):858-64
references.pmid: 17215342
references.citation: J Infect. 2007 May;54(5):504-8
references.pmid: 17084902
references.citation: Mycoses. 2003 Sep;46(8):307-11
references.pmid: 12950899
references.citation: Braz J Infect Dis. 2002 Jun;6(3):118-23
references.pmid: 12144747
references.citation: J Clin Microbiol. 1996 Sep;34(9):2154-7
references.pmid: 8862576
references.citation: J Clin Microbiol. 2005 Jun;43(6):2586-9
references.pmid: 15956368
references.citation: J Clin Microbiol. 2008 Nov;46(11):3585-90
references.pmid: 18784314
references.citation: J Clin Lab Anal. 2009;23(5):324-30
references.pmid: 19785043
references.citation: J Clin Microbiol. 2004 May;42(5):2249-51
references.pmid: 15131203
references.citation: Antimicrob Agents Chemother. 2003 May;47(5):1647-51
references.pmid: 12709335
references.citation: J Antimicrob Chemother. 2005 Jan;55(1):106-9
references.pmid: 15546969
references.citation: J Antimicrob Chemother. 1994 Nov;34(5):613-27
references.pmid: 7706157
references.citation: BMC Infect Dis. 2006 Dec 05;6:173
references.pmid: 17147804
references.citation: Mycoses. 2006;49 Suppl 2:18-23
references.pmid: 17022757
references.citation: J Clin Microbiol. 2001 Jul;39(7):2458-62
references.pmid: 11427554
references.citation: J Clin Microbiol. 1999 Dec;37(12):3856-9
references.pmid: 10565896
references.citation: Arq Gastroenterol. 2009 Jan-Mar;46(1):32-7
references.pmid: 19466307
references.citation: Antimicrob Agents Chemother. 2000 Oct;44(10):2752-8
references.pmid: 10991856
references.citation: Clin Microbiol Infect. 2001 Nov;7(11):609-18
references.pmid: 11737085
references.citation: Afr Health Sci. 2008 Sep;8(3):142-8
references.pmid: 19357740
references.citation: Rev Inst Med Trop Sao Paulo. 2008 Jan-Feb;50(1):7-10
references.pmid: 18327480
references.citation: J Clin Microbiol. 1994 Apr;32(4):1115-8
references.pmid: 8027327