Antifungal susceptibility of candida isolates at the American University of Beirut Medical Center

For the first time from Lebanon, the antifungal susceptibility patterns of 70 consecutive clinical candida isolates (each from one patient) representi ng 48 C. albicans, 12 C. tropicalis, 6 C. parapsilosis, 2 C. kruseii, and 2 C. (Torulopsis) glabrata were studied against amphotericin B (AP), 5-fluor ocytosine (FC), ketoconazole (KE), fluconazole (FL), and itraconazole (IT) using the Epsilometer test (E-test; AB Biodisk, Solna, Sweden). The MIC90 ( and MIC range, mg/l) determined, at 24 h incubation, for each antifungal ag ent against C. albicans were: AP 0.032 (less than or equal to 0.002-0.064), FC 0.75 (0.023-2), KE 0.064 (0.002- >32), FL 2 (0.064- >256), and IT 0.19 (0.012-2), against C. tropicalis were: AP 0.016 (<0.002-0.047), FC 0.125 (0 .023-0.19), KE 0.094 (0.012-0.19), FL 2 (0.5-2). and IT 0.5 (0.047-1) and a gainst C. parapsilosis were: AP < 0.002 (< 0.002-0.002), FC 0.047 (0.003-0. 5), KE 0.004 (0.002-0.004), FL 0.125 (0.032-0.19), and IT 0.004 (< 0.002-0. 004). Based on the NCCLS established MICs breakpoints, resistance was found among C. albicans to FL (MIC greater than or equal to 6 mg/l) and IT (MIC greater than or equal to 1 mg/l) in 6 and 4% respectively, and among C. tro picalis to IT in 17% of the isolates. The susceptibility dependent upon dos e (S-DD) was noted only to IT (MIC 0.25-0.5 mg/l) among C. albicans (8%) an d C. tropicalis (58%). MICs determination at 48 h incubation were higher, s howed more resistance rates and more endpoint trailing particularly with th e azoles drugs. The small numbers of C. kruseii and C. glabrata preclude pr oviding meaningful results. Thus, this study indicates that the antifungal susceptibility to AP and FC, resistance to azoles drugs is encountered in a range of 4-17% among candida isolates in this country. (C) 1998 Published by Elsevier Science B.V. and International Society of Chemotherapy. All rig hts reserved.