Clinical correlates of antifungal macrodilution susceptibility test results for non-AIDS patients with severe Candida infections treated with fluconazole

Although the clinical correlates of the reference antifungal susceptibility test results in hematogenous and deep-seated Candida infection are still c ontroversial, we evaluated the clinical correlates of this test in deep-sea ted Candida infections in non-AIDS patients. Thirty-two non-AIDS patients w ith hematogenous or deep-seated Candida infections were treated,vith intrav enous fluconazole (400 mg a day), and the clinical outcomes were evaluated, Coexisting bacterial infections were treated with appropriate antibiotics, superinfection or reinfection was excluded, inadequate fluconazole therapy was avoided, and essential surgical intervention was performed. The MICs o f fluconazole for these 32 Candida isolates were determined according to th e M27-A procedure approved by the National Committee on Clinical Laboratory Standards. MICs were interpreted as susceptible (less than or equal to 8 m u g/ml), dose-dependent susceptible (16 to 32 mu g/ml), and resistant (less than or equal to 64 mu g/ml) according to the criteria of the M27-A standa rd. The success rates were 79% (19 of 24; 95% confidence interval [CI], 59 to 93%) in the susceptible category, 66% (4 of 6; 95% CI, 19 to 95%) in the dose-dependent susceptible category, and 0% (0 of 2; 95% CI, 0 to 83%) in the resistant category. We conclude that the clinical correlation of the re ference antifungal susceptibility test results is high in hematogenous and deep-seated Candida infections.