JCM Accepts, published online ahead of print on 4 November 2009

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J. Clin. Microbiol. doi:10.1128/JCM.01096-09
Copyright (c) 2009, American Society for Microbiology and/or the Listed Authors/Institutions. All Rights Reserved.

Antifungal susceptibility of 205 Candida sp. primarily isolated during invasive candidiasis. Comparison of the Vitek2 system with CLSI broth microdilution and Etest methods.

N. Bourgeois, L. Dehandschoewercker, S. Bertout, P.-J. Bousquet, P. Rispail, and L. Lachaud^*

Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Nîmes, Faculté de Médecine de Montpellier-Nîmes, Université Montpellier I, France; Laboratoire de Parasitologie et de Mycologie Médicale, UMR 145 (IRD-UM1) VIH-SIDA et maladies associées, Faculté de Pharmacie, Montpellier, France; BESPIM (Biostatistique, Epidémiologie clinique, Santé Publique et Information Médicale), Centre Hospitalier Universitaire de Nîmes, Faculté de Médecine de Montpellier-Nîmes, Université Montpellier I, France; Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Montpellier, Faculté de Médecine de Montpellier-Nîmes, Université Montpellier I, France

^* To whom correspondence should be addressed. Email: llachaud{at}gmail.com.

Infections due to Candida are frequent, particularly in immuno-compromised and intensive care unit patients. Antifungal susceptibility tests are now required to optimize antifungal treatment given the emergence of acquired antifungal resistance in some Candida species. An antifungal susceptibility automated method, the Vitek2 system, was evaluated. The Vitek2 system (VK2) was compared to the CLSI broth microdilution reference method and the Etest procedure. For this purpose, 205 clinical isolates of Candida sp. including 11 different species, were tested for fluconazole, voriconazole and amphotericin B susceptibility. Regarding results for azole molecules, essential agreement ranged from 25% to 100% depending on the method used and Candida species tested. Categorical agreements for all species averaged 92.2% and ranged from 14.3 to 100% depending on the 24-h or 48-h MIC reading for the Etest and CLSI methods and the Candida species. Results obtained for Candida albicans showed excellent categorical and essential agreements with the two comparative methods. For Candida glabrata, essential agreement was high with the CLSI method, but low with the Etest method and several very major errors in interpretation were observed between the Vitek2 and Etest methods for both azoles. Low MIC values with fluconazole were obtained for all the Candida krusei isolates, but the VK2' expert software corrected all the results obtained to resistant.

Amphotericin B results showed MICs 1 mg/L for 201 (VK2), 190 (CLSI), and 202 (Etest) isolates.

The AST-YS01 Vitek 2 card system (bioMérieux) is a reliable and practical standardized automated antifungal susceptibility test. Nevertheless, more assays are needed to better evaluate Candida glabrata fluconazole sensitivity.