Pattern of susceptibility to azoles by E test method in candidemia patients


  • Sri Janani B. Department of Microbiology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai
  • Premamalini T. Department of Microbiology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai
  • Rajyoganandh S.V. Department of Microbiology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai
  • Anupma J. Kindo Department of Microbiology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai



Candida sp, E test, Fluconazole, Ketoconazole, Itraconazole, Voriconazole


Background: Blood stream infections due to Candida sp have considerably increased in recent years, along with the increase of drug-resistant isolates in immunocompromised patients. This increase in resistance makes it important to determine the antifungal susceptibility profile of each Candida species isolated from blood prior to treatment. Hence, this study was done to detect the resistant strains of Candida causing candidemia.

Methods: About Seventy Candida species isolated from blood cultures were used for this study. These included 27 Candida albicans, 23 Candida tropicalis, 8 Candida parapsilosis, 3 Candida krusei, 2 Candida glabrata and 7 other candida species. Minimum inhibitory concentrations (MIC) of the most commonly used azoles like fluconazole, ketoconazole, itraconazole and voriconazole were determined by E test method.

Results: The resistance percentage of Candida albicans for fluconazole and itraconazole was 11.1% and 7.4%; fluconazole resistance in Candida tropicals was 8.7%. Candida parapsilosis had good activity against all azoles with only 12.5% resistance for itraconazole.

Conclusions: Fluconazole had good activity against most of the Candida sp except for Candida glabrata and Candida krusei with MIC 90 > 256 µg/ml. Itraconazole was less effective for Candida albicans, Candida glabrata and Candida parapsilosis (MIC 90 >32 µg/ml). Voriconazole was found to be the most effective drug against all species of Candida with low MIC values (MIC 90 < 0.25 µg/ml). Hence it can be used to treat blood stream infections caused by Candida species.



Chander J. Candidiasis. In: A text book of Medical Mycology. New Delhi: Metha Publishers, 2009; 266-290.

Kanafani ZA, John R. Perfect. Resistance to Antifungal Agents: Mechanisms and Clinical Impact. Clinical Infectious Diseases. 2008;46(1):120-8.

Pfaller MA, Diekema DJ, Sheehan DJ. Interpretive breakpoints for fluconazole and Candida revisited: a blueprint for the future of antifungal susceptibility testing. Clin Microbiol Rev. 2006;19:435–47.

Clinical and Laboratory Standards Institute (CLSI). Reference method for broth dilution antifungal susceptibility testing of yeasts: Approved standard, 3rd. ed. CLSI document M27-A3. Wayne, PA: CLSI; 2008.

NCCLS. Reference method for broth dilution antifungal susceptibility testing of yeasts: approved standard. NCCLS document M27-A2. Wayne, PA: NCCLS, 2002.

Pfaller MA, Diekema DJ, Boyken L, Messer SA, Tendolkar S, Hollis RJ. Evaluation of the E test and disk diffusion methods for determining susceptibilities of 235 bloodstream isolates of Candida glabrata to fluconazole and voriconazole. J Clin Microbiol. 2003;41:1875-80.

Pfaller MA, Diekema DJ. Twelve years of fluconazole in clinical practice: global trends in species distribution and fluconazole susceptibility of bloodstream isolates of Candida. Clin Microbiol Infect. 2004;10(Suppl 1):11-23.

Guinea J, Recio S, Escribano P, Torres-Narbona M, Peláez T, Sánchez-Carrillo C, et al. Rapid Antifungal Susceptibility Determination for Yeast Isolates by Use of Etest Performed Directly on Blood Samples from Patients with Fungemia. J Clin Microbiol. 2010;48(6):2205.

Schwarz S, Silley P, Simjee S. Editorial: Assessing the antimicrobial susceptibility of bacteriaobtained from animals. J Antimicrob Chemother. 2014;10:1093.

Hoda H, et al. Bloodstream Infections Due To Candida Species and Antifungal Susceptibility Profile. Egyptian Journal of Medical Microbiology. 2009;18:4

Law D, Moore CB, Wardle HM, Ganguli LA, Keaney MG, Denning DW. High prevalence of antifungal resistance in Candida spp. from patients with AIDS. J Antimicrob Chemother. 1994;34:659-68.

Teseng YH, Lee WT, Kuo TC. In-Vitro susceptibility of fluconazole and amphotericin B against Candida isolates from women with vaginal candidiasis in Taiwan. J Food Drug Analysis. 2005;13:12–6.

Mokaddas EM, Al-Sweih NA, Khan ZU. Species distribution and antifungal susceptibility of Candida bloodstream isolates in Kuwait: a 10-year study. Journal of Medical Microbiology. 2007;56:255–9.

Oberoi JK, Wattal C, Goel N. Non-albicans Candida species in blood stream infections in a tertiary care hospital at New Delhi, India. Indian J Med Res. 2012;997-1003.

Chander J, Singla N, Sidhu SK, Gombar S. Epidemiology of Candida blood stream infections: experience of a tertiary care in North India. J Infect Dev Ctries. 2013;7(9):670-5.

Badiee P, Alborzi A, Davarpanah MA, Shakiba E. Distributions and antifungal susceptibility of Candida species from mucosal sites in HIV positive patients. Arch Iran Med. 2010;13:282–7.

Berry V, Badyal DK. Sensitivity of clinical isolates of Candida species to antifungal drugs. J Med Education Res. 2006;8:214–7.

Badiee P, Alborzi A, Shakiba E, Ziyaeyan M, Rasuli M. Molecular identification and in-vitro susceptibility of Candida albicans and Candida dubliniensis isolated from Immunocompromised patients. Iranian Red Cres Med. J 2009;11:391–7.

Saporiti AM, Gómez D, Levalle S, Galeano M, Davel G, Vivot W, et al. Vaginal candidiasis: etiology and sensitivity profile to antifungal agents in clinical use. Rev Argent Microbiol. 2001;33:217–22.

Bauters TG, Dhont MA, Temmerman MI, Nelis HJ. Prevalence of vulvovaginal candidiasis and susceptibility to fluconazole in women. Am J Obstet Gynecol. 2002;187:569–74.

Citak S, Ozçelik B, Cesur S, Abbasoğlu U. In vitro susceptibility of Candida isolated from blood culture to some antifungal agents. Jpn J Infect Dis. 2005;58:44–6.

Swinne D, Watelle M, Van der Flaes M, Nolard N. In vitro activities of voriconazole, fluconazole, itraconazole and amphotericin B against 132 non-albicans bloodstream yeast isolates. Mycoses. 2004;47:177–83.

Mímica LMJ, Ueda SMY, Martino MDV, Navarini A, Martini IJ. Candida infection diagnosis: evaluation of Candida species identification and characterization of susceptibility profile. J Bras Patol Med Lab. 2009;45:17–23.

Sabatelli F, Patel R, Mann PA, Mendrick CA, Norris CC, Hare R, et al. In vitro activities of posaconazole, fluconazole, itraconazole, voriconazole, and amphotericin B against a large collection of clinically important molds and yeasts. Antimicrob Agents Chemother. 2006;50:2009–15.

Marshall Lyon G. Antifungal Susceptibility Testing of Candida Isolates from the Candida Surveillance Study. Journal of clinical microbiology. 2010;48(4):1270–5.

Madhavan, Jamal P, Chong F, PP. In vitro activity of fluconazole and voriconazole against clinical isolates of Candida spp. by E-test method. Tropical Biomedicine. 2010;27(2):200–7.




How to Cite

B., S. J., T., P., S.V., R., & Kindo, A. J. (2017). Pattern of susceptibility to azoles by E test method in candidemia patients. International Journal of Research in Medical Sciences, 3(8), 2118–2122.



Original Research Articles