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Journal of Clinical Microbiology, January 1998, p. 153-156, Vol. 36, No. 1
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.

Interpretation of Trailing Endpoints in Antifungal Susceptibility Testing by the National Committee for Clinical Laboratory Standards Method

Sanjay G. Revankar,1,* William R. Kirkpatrick,1 Robert K. McAtee,1 Annette W. Fothergill,1 Spencer W. Redding,1 Michael G. Rinaldi,2 and Thomas F. Patterson1,2

University of Texas Health Science Center at San Antonio1 and Audie Murphy Division, South Texas Veterans Health Care System,2 San Antonio, Texas

Received 14 July 1997/Returned for modification 22 September 1997/Accepted 10 October 1997

Trailing endpoints remain a problem in antifungal susceptibility testing using the National Committee for Clinical Laboratory Standards (NCCLS) method. For isolates for which trailing endpoints are found, MICs of <= 1 µg/ml at 24 h and of >64 µg/ml at 48 h are usually observed. In a study of human immunodeficiency virus (HIV)-infected patients with oropharyngeal candidiasis, we identified three patients with multiple serial isolates for which trailing endpoints were observed with fluconazole. At 24 h, MICs were generally <= 1 µg/ml by both broth macro- and microdilution methods. However, at 48 h, MICs were >64 µg/ml, while the organism remained susceptible by agar dilution testing with fluconazole. Most episodes of oropharyngeal candidiasis with trailing-endpoint isolates responded to doses of fluconazole as low as 100 mg/day. Two patients had both susceptible and trailing-endpoint isolates by NCCLS broth macro- and microdilution testing; these isolates were found to be the same strain by pulsed-field gel electrophoresis using restriction fragment length polymorphisms. Another patient had two different strains, one for which trailing endpoints were observed and one which was susceptible at 48 h. Trailing endpoints may be seen with selected isolates of a strain or may be a characteristic finding for most or all isolates of a strain. In addition, with isolates for which trailing endpoints are observed, reading the endpoint for the NCCLS method at 24 h may be more appropriate.

* Corresponding author. Mailing address: University of Texas Health Science Center at San Antonio, Department of Medicine/Infectious Diseases, 7703 Floyd Curl Dr., San Antonio, TX 78284-7881. Phone: (210) 567-4823. Fax: (210) 567-3303. E-mail: REVANKAR{at}UTHSCSA.EDU.

Journal of Clinical Microbiology, January 1998, p. 153-156, Vol. 36, No. 1
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.


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