JAC Advance Access published online on January 6, 2003
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkg077
© 2003 by The British Society for Antimicrobial Chemotherapy
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Original article
1 Department of Microbiology, Hope Hospital,
Eccles Old Road, Salford M6 8HD
* Corresponding author. E-mail: ddenning{at}man.ac.uk.
Received 12 April 2001
; revised 20 June 2001
; accepted 5 November 2002
Optimal methods for susceptibility testing of Candida spp.
with flucytosine have not been determined. Breakpoints were recommended
in 1984, but never validated. In this study, we compared the 1984
recommended macrodilution broth method (using an 80% endpoint)
with a modification of the more recent NCCLS-recommended microdilution
broth method with three endpoints—spectrophotometric 50% and
80% and a no growth endpoint determined by eye. NCCLS and British
Society for Medical Mycology (BSMM) breakpoints were also compared.
One hundred and fifty isolates comprised of Candida
albicans, Candida tropicalis, Candida
krusei, Candida glabrata, Candida
parapsilosis and Candida lusitaniae were tested.
Reproducibility was excellent. For C. albicans (n = 65), the correlation between tests
was excellent (>75%), with few major discrepancies
(<5%). For C. tropicalis (n = 27),
correlation was good (59%), but there were a small number
of major discrepancies (up to 11%, depending on breakpoint
used). Results by the broth macrodilution method were generally
higher than both microdilution methods for C. glabrata (n = 16;
correlation of 18.8%), but only one major discrepancy was
seen. Ten of the 11 C. parapsilosis isolates
tested were susceptible by all methods, regardless of breakpoint chosen,
with a correlation of 18.2%, but no major discrepancies
were seen. A correlation between all methods (50%) was
seen with C. lusitaniae (n = 10),
with many isolates resistant or intermediate. In contrast, correlation
between methods for C. krusei was poor (<5%);
NCCLS microtitre modification produced results that were classified
as intermediate or resistant, regardless of the breakpoint used.
The methodology for susceptibility testing C. albicans is robust.
Additional work to optimize susceptibility testing with flucytosine
is necessary for non-albicans Candida species,
especially C. krusei.
Comparison of three methods for in
vitro susceptibility testing of Candida species
with flucytosine
2 Section of Infectious Diseases,
Department of Medicine, Hope Hospital,
Eccles Old Road, Salford M6 8HD; School
of Medicine, University of Manchester, Manchester M13 9PL, UK
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