COMPARATIVE-EVALUATION OF 3 ANTIFUNGAL SUSCEPTIBILITY TEST METHODS FOR CANDIDA-ALBICANS ISOLATES AND CORRELATION WITH RESPONSE TO FLUCONAZOLE THERAPY

In vitro susceptibilities were determined for 56 Candida albicans isol ates obtained from the Oral cavities of 41 patients with human immunod eficiency virus infection. The agents tested included fluconazole, itr aconazole, ketoconazole, flucytosine, and amphotericin B. MICs were de termined by the broth microdilution technique following National Commi ttee for Clinical Laboratory Standards document M27-P (M27-P micro), a broth microdilution technique using high-resolution medium (IIR micro ), and the Etest with solidified yeast-nitrogen base agar. The in vitr o findings were correlated with in vivo response to fluconazole therap y for oropharyngeal candidiasis. For all C. albicans isolates from pat ients with oropharyngeal candidiasis not responding to fluconazole MIC s were found to be greater than or equal to 6.25 mu g/ml by the M27-P micro method and greater than or equal to 25 mu g/ml by the HR micro m ethod as well as the Etest, However, for several C. albicans isolates from patients who responded to fluconazole therapy MICs found to be ab ove the suggested breakpoints of resistance, The appropriate rank orde r of best agreement between the M27-P micro method and HR micro method was amphotericin B > fluconazole > flucytosine > ketoconazole > itrac onazole. The appropriate rank order with best agreement between the M2 7-P micro method and the Etest was flucytosine > amphotericin B > fluc onazole > ketoconazole greater than or equal to itraconazole. It could be concluded that a good correlation between in vitro resistance and clinical failure was found with all methods. However, the test methods used in this study did not necessarily predict clinical response to t herapy with fluconazole.