Cross-resistance phenotypes of fluconazole-resistant Candida species: results with 655 clinical isolates with...

Candida species test results with two broth macrodilution antifungal susceptibility methods were compared using 655 clinical isolates, and the frequency of fluconazole resistance and phenotypes of azole cross resistance are detailed. A method with an 80% inhibition endpoint (as compared to clear tube endpoint) suggested greater fluconazole susceptibility to C. albicans but had a less pronounced effect on C. glabrata, and seemed to have a negligible influence on results with C. parapsilosis and C. tropicalis. The latter were grouped as susceptible and resistant (based on achievable blood levels), respectively, by both methods. Cross resistance was method dependent and more pronounced with itraconazole than ketoconazole. In vivo correlations are needed to validate the groupings proposed by any in vitro method.