Using the Sensititre YeastOne, Vitek 2 System and Disk Diffusion for Antifungal Susceptibility Testing of Candida Species Isolated from Patients in Thailand
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Background: Antifungal susceptibility testing (AFST) is an important tool to support candidiasis treatment. Broth microdilution (BMD), a reference AFST, is expensive, labor-intensive, and time-consuming. To overcome these shortcomings, disk diffusion (DD) and commercial kits such as Sensititre YeastOne (SYO) and Vitek 2 (VT) have been developed and routinely employed. Objective: To evaluate DD, SYO, and VT in the AFST of Candida species collected from patients with candidiasis. Methods: Forty strains of five Candida species were tested with AFST using DD, SYO, and VT. Their susceptibility profiles were evaluated by their discrepancies. The errors and agreements between each method were investigated. Results: Among the three tests, most strains were sensitive(S)/wild-type (WT). Only two strains of C. tropicalis were resistant to fluconazole (FLU) and voriconazole (VOR). Discrepancy from the three tests was found in five drugs. FLU had the highest error number. DD had a higher error number than SYO and VT, with categorical agreement (CA) values of 86.00% and 84.38%, respectively. SYO and VT had the highest CA of 98.75%. Conclusion: SYO, VT, and DD were reliable for detecting the S/WT phenotype. SYO and VT had higher agreement than with DD; thus, they are more reliable for detecting or confirming resistant phenotypes. DD could still be used routinely because it is cheaper and easier to use. However, patient benefit must be the most important consideration in choosing the AFST method.
Abstract
Background: Antifungal susceptibility testing (AFST) is an important tool to support candidiasis treatment. Broth microdilution (BMD), a reference AFST, is expensive, labor-intensive, and time-consuming. To overcome these shortcomings, disk diffusion (DD) and commercial kits such as Sensititre YeastOne (SYO) and Vitek 2 (VT) have been developed and routinely employed. Objective: To evaluate DD, SYO, and VT in the AFST of Candida species collected from patients with candidiasis. Methods: Forty strains of five Candida species were tested with AFST using DD, SYO, and VT. Their susceptibility profiles were evaluated by their discrepancies. The errors and agreements between each method were investigated. Results: Among the three tests, most strains were sensitive(S)/wild-type (WT). Only two strains of C. tropicalis were resistant to fluconazole (FLU) and voriconazole (VOR). Discrepancy from the three tests was found in five drugs. FLU had the highest error number. DD had a higher error number than SYO and VT, with categorical agreement (CA) values of 86.00% and 84.38%, respectively. SYO and VT had the highest CA of 98.75%. Conclusion: SYO, VT, and DD were reliable for detecting the S/WT phenotype. SYO and VT had higher agreement than with DD; thus, they are more reliable for detecting or confirming resistant phenotypes. DD could still be used routinely because it is cheaper and easier to use. However, patient benefit must be the most important consideration in choosing the AFST method.