Study of faecal colonization by vanA-containing Enterococcus strains in healthy humans, pets, poultry and wild animals in Portugal.

Fluconazole MICs obtained with the modified BMD tests and Etest read at 24 and 48 h were compared with the reference BMD MICs read at 48 h. Discrepancies between MICs of no more than ±1 dilution were used to calculate the percentage of agreement. Categorical agreement was defined when the applied method gave the same category result compared with the reference BMD category read at 48 h. Results are summarized in Table 1. In vitro susceptibility test results demonstrated relatively high fluconazole MICs for C. inconspicua clinical isolates by all applied methods. Compared with the standard method, overall agreement of MICs obtained with the studied methods was excellent with the exception of the Etest read at 48 h. After 24 h of incubation, categorical agreement of the normal and large inoculum BMD method was very good, but out of five R strains three and two, respectively, were misdiagnosed as S-DD. Using a large inoculum BMD method read at 48 h and Etest read at 24 and 48 h, poor categorical agreements were observed, though all R isolates were diagnosed correctly. The Fungitest gave good categorical agreement compared with the standard method, but four of five R isolates were misdiagnosed as S-DD. This study demonstrates, for the first time, the applicability of alternative fluconazole susceptibility testing methods in the case of C. inconspicua. Etest read at 24 h is a good choice for screening the fluconazole resistance of C. inconspicua, though Etest results tended to be higher (generally within one dilution) than the standard BMD results. Correct identification is a major step to adequate drug choice, mainly in the case of rare Candida species as we demonstrated in our previous study of C. inconspicua. 1 However, if a clinician urgently needs fluconazole susceptibility results, before the correct identification becomes available, Etest read at 24 h safely detects the decreased fluconazole susceptibility of C. inconspi-cua. In a proven life-threatening C. inconspicua infection, the empirical fluconazole therapy should, of course, be switched to amphotericin B. 6 Though the efficacy of caspofungin and vorico-nazole has not been tested in a systematic study, they seem to be reasonable alternatives. enzyme analysis of ribosomal DNA shows that Candida inconspicua clinical isolates can be misidentified as Candida norvegensis with traditional diagnostic procedures. In vitro activity of five antifungal agents against uncommon clinical isolates of Candida species. activities of voriconazole, posaconazole, and four licensed systemic antifungal agents against …