Antifungal Susceptibility Pattern among Candida species: An Evaluation of Disc Diffusion and Micro Broth Dilution Method

Year 2018, Volume: 08 Issue: 03, 97 - 102, 15.09.2018

Abirami Lakshmy Jayachandran Radhika Katragadda Thyagarajan Ravinder Leela Vajravelu Lavanya Manorajan S. Hemalatha Kaliappan Shanmugam

https://doi.org/10.5799/jmid.458457

Cited By: 4

Abstract

Objective: Candida species are emerging as a significant pathogen certain
species of Candida like Candida krusei
are inherently resistant to azoles. In vitro susceptibility testing is
essential for guiding therapy. The present study aims to study the antifungal
susceptibility pattern of Candida isolates by disc diffusion and micro broth
dilution method and to evaluate the degree of agreement between both the
techniques.

Methods: Candida
isolated from specimens like Oropharyngeal swabs, blood, pus and wound swabs
were included in the study. Speciation was done as per standard microbiological
methods. Antifungal resistance was determined by disc diffusion method for
fluconazole, Itraconazole, amphotericin B, nystatin and clotrimazole.
Microbroth dilution method was performed for fluconazole, Itraconazole and
amphotericin B. The degree of agreement between both the methods for the
resistant isolates was analysed by deriving the kappa value.

Results: Out
of the 156 Candida isolates obtained, Candida
albicans was the most common species isolated. By disc diffusion method
fluconazole and Itraconazole showed an overall resistance of 34 (21.7%) and 27
(17.3%), respectively. Using micro broth dilution method, Fluconazole and
Itraconazole had a resistance percentage of 35 (22.4%) and 29 (18.5%),
respectively. There was a good agreement between both the methods in detecting
the percentage of resistant isolates for fluconazole and Itraconazole (κ=0.9).

Conclusion: It is essential to perform susceptibility testing for
all the Candida isolates for providing crucial information about the resistance
pattern and help in choosing the appropriate antifungal drug for therapy. Disc
diffusion method which is easy to perform can be utilized for day to day
practice. J Microbiol Infect Dis 2018; 8(3):97-101

Keywords

Broth micro dilution, Candida, Disc diffusion

References

• 1. Gill K, Kumar S, Xess I, Dey S. Novel synthetic anti-fungal tripeptide effective against Candida krusei. Indian J Med Microbiol 2015; 33 (1):110-116. 2. Jayachandran AL, Katragadda R, Thyagarajan R, et al. Oral Candidiasis among Cancer Patients Attending a Tertiary Care Hospital in Chennai, South India: An Evaluation of Clinic mycological Association and Antifungal Susceptibility Pattern. Can J Infect Dis Med Microbiol 2016; 8758461. http://dx.doi.org/10.1155/2016/8758461 3. Giri S, Kindo AJ. Evaluation of Antifungal susceptibility testing in Candida isolates by Candifast and disk-diffusion method. Indian J Pathol Microbiol 2014; 57:595-7. 4.Agarwal S, Manchanda V, Verma N et al. Yeast identification in routine clinical microbiology laboratory and its clinical relevance. Indian J Med Microbiol.2011; 29 (2): 172-177. 5. Clinical and Laboratory Standards Institute. Method for antifungal disk diffusion susceptibility testing of yeasts; approved guideline, 2nd ed., M44-A2.Clinical and Laboratory Standards Institute, Wayne, PA.USA 2008. 6 .Clinical and Laboratory Standards Institute (CLSI), “Reference method for broth dilution antifungal susceptibility testing of yeasts.3rd ed., Document M27-A3, Wayne, Pa, USA, 2008. 7. Tankhiwale S, Gajbhiye S, Powar R. fluconazole susceptibility testing of Candida species by disc diffusion and agar dilution method. J Evolut Med Dent Sci 2012; 1(4): 527-531. 8 .Ying Y, Zhang J, Huang SB et al. Fluconazole susceptibility of 3,056 clinical isolates of Candida species from 2005 to 2009 in a tertiary-care hospital. Indian J Med Microbiol 2015; 33(3):413-415. 9. Pfaller MA, Diekema DJ, Gibbs DL et al. Global Antifungal Surveillance Group Results from the ARTEMIS DISK Global Antifungal Surveillance Study, 1997 to 2007: A 10.5-year analysis of susceptibilities of Candida species to fluconazole and voriconazole as determined by CLSI standardized disk diffusion. J Clin Microbiol 2010; 48 (4):1366-77. 10. Gandhi TN, Patel MG, Jain MR. Antifungal Susceptibility of Candida against Six Antifungal Drugs by Disk Diffusion Method Isolated from Vulvovaginal Candidiasis. Int J Cur Res Rev 2015; 7 (11): 20-25. 11. Kumar D, Bhattacharyya S, Gupta P, et al. Comparative Analysis of Disc Diffusion and E-test with Broth Micro-dilution for Susceptibility Testing of Clinical Candida Isolates Against Amphotericin B, Fluconazole, Voriconazole and Caspofungin. J Clin Diag Res 2015; 9 (11): 1-4. 12.Jayalakshmi L, Ratna Kumari G, Samson SH. Isolation, Speciation and Antifungal Susceptibility Testing of Candida from Clinical Specimens at a Tertiary Care Hospital. Sch J App Med Sci, 2014; 2(6E):3193-198. 13.Adhikary R, Joshi S. Species distribution and antifungal susceptibility of candidemia at a multi super specialty centre in Southern India. Indian J Med Microbiol 2011; 29(3):309‑311. 14.Rex JH, Rinaldi MG, Pfaller MA. Resistance of Candida species to fluconazole. Antimicrob Agents Chemother 1995; 39(1): 1-8. 15. Kothari A, Sagar V. Epidemiology of candida blood stream infections in a tertiary care institute in India. Indian J Med Microbiol 2008; 27(2):171‑172. 16. Matar MJ, Zeichner LO, Paetznick VL, et al. Correlation between E-Test, Disk Diffusion, and Microdilution Methods for Antifungal Susceptibility Testing of Fluconazole and Voriconazole. Antimicrob Agents Chemother. 2003; 47(5): 1647-1651. 17. Negri M, Henrique’s M, Svidzinski TI, et al. Correlation between E test, disk diffusion, and microdilution methods for antifungal susceptibility testing of Candida species from infection and colonization. J Clin Lab Anal 2009; 23(5): 324-330.