The Evaluation of the Combination of Caspofungin with Voriconazole and Amphotericin B against Clinical Candida krusei Isolates by Etest and Disk Diffusion Methods.
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Date
2014-05
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Abstract
Background: C. krusei is an opportunistic fungal pathogen that known of its intrinsic
fluconazole resistance and its frequency is increasing especially among hematology
patients. The increase in the frequency of high mortality fungal infections have accelerated
the efforts of new drug development with broad spectrum, low toxicity and the studies
including their combination. However, there is no standardized method to evaluate the
activity of drug combinations.
Aims: To evaluate the activity of caspofungin (CAS) with voriconazole (VOR) and
amphotericin B (AMB) alone and in combination and the utility of Etest and disk diffusion
methods for antifungal combinations.
Methodology: The minimum inhibitory concentrations of VOR, CAS and AMB against 30
clinical C. krusei isolates were determined by using Etest, disk diffusion and reference broth
microdilution methods. Combinations of CAS with VOR and CAS with AMB were evaluated
using disk diffusion (three different ways) and Etest (two different ways) methods. Results: All isolates tested were susceptible to VOR and CAS in vitro by all three methods.
Categorical agreements of Etest and disk diffusion methods with reference microdilutiontest
were 100% for CAS and VOR (for each method), 86.7% and 50% for AMB, respectively. In
the all ways of both combination methods, we did not observe distinctly antagonistic or
synergic interaction.
Conclusion: Etest and disk diffusion could be easy, convenient, and nontime-consuming
alternative methods to evaluate the antifungal combinations. The combinations of CAS with
VOR and AMB exhibited promising results because of an apparent antagonistic interaction
was not detected in this study.
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Keywords
Antifungal combination, Etest, Disk diffusion, Candida krusei
Citation
Oz Yasemin, Kiremitci Abdurrahman, Aksit Filiz, Kiraz Nuri. The Evaluation of the Combination of Caspofungin with Voriconazole and Amphotericin B against Clinical Candida krusei Isolates by Etest and Disk Diffusion Methods. British Microbiology Research Journal. 2014 May; 4(5): 497-508.