title: Comparative Analysis of Disc Diffusion and E-test with Broth Micro-dilution for Susceptibility Testing of Clinical Candida Isolates Against Amphotericin B, Fluconazole, Voriconazole and Caspofungin.
abstract: BACKGROUND
  Antifungal susceptibility testing remains an area of intense interest because of the increasing number of clinical isolates resistant to antifungal therapy. Clinical and Laboratory Standards Institute has proposed reference broth micro dilution (BMD) method for susceptibility testing. The reference method is time-consuming and poorly suited for the routine clinical laboratory setting. Agar-based susceptibility testing methods, disk diffusion (DD) method and the E-test method can be an easier, reliable and less time consuming alternative for the BMD method.
  
  
  OBJECTIVE
  To compare the results of Amphotericin B, fluconazole, voriconazole, and Caspofungin susceptibility testing by DD, and the E-test method with the CLSI reference method for clinical Candida isolates.
  
  
  METHODS
  Broth Microdilution (BMD), E-test and Disk diffusion testing of the various clinical Candida isolates was performed in accordance with CLSI documents. The results obtained were analysed and compared.
  
  
  RESULTS
  The categorical agreement for Amphotericin B, fluconazole, voriconazole, and Caspofungin susceptibility results by E-test and DD method was 65.2%, 67.4%; 100%, 82.6%; 100%, 100%; 100%, 97.8% respectively.
  
  
  CONCLUSIONS
  The agar-based E-test and disk diffusion methods are reliable alternatives to the BMD method for Candida isolates when test susceptible to fluconazole, voriconazole, and Caspofungin, however the susceptibility testing results must be interpreted with caution in case of Amphotericin B.
authors.affiliation: Assistant Professor, Department of Microbiology, IMS, BHU Varanasi, U.P., India .
authors.forename: Deepak
authors.initials: D
authors.lastname: Kumar
authors.affiliation: Assistant Professor, Department of Microbiology, AIIMS , Patna, India .
authors.forename: Sayan
authors.initials: S
authors.lastname: Bhattacharyya
authors.affiliation: Assistant Professor, Department of Microbiology, King George's Medical University , Lucknow, India .
authors.forename: Prashant
authors.initials: P
authors.lastname: Gupta
authors.affiliation: Professor, Department of Microbiology, King George's Medical University , Lucknow, India .
authors.forename: Gopa
authors.initials: G
authors.lastname: Banerjee
authors.affiliation: Professor and HOD, Department of Microbiology, King George's Medical University , Lucknow, India .
authors.forename: Mastan
authors.initials: M
authors.lastname: Singh
keywords: Antifungal susceptibility testing; Antifungal therapy; CLSI reference method