Araştırma Makalesi
Comparison of the E test with the CLSI Broth Microdilution Reference Method for Testing Fluconazole against Candida spp. Isolated from Blood Cultures
Öz
Increased resistance against antifungal agents recently shows the
importance of antifungal susceptibility testing especially to Candida
spp. isolated from invasive infections. Although the Broth Microdilution
(BMD) method has been standardized as an antifungal susceptibility
testing by “Clinical and Laboratory Standards Institute (CLSI)”,
difficulties in the practice of the this method pushed the researchers to
seek more practical methods that can be used in routine laboratories.
The aim of this study was to compare E-test method with standard
BMD method for antifungal susceptibility testing of Candida spp.
isolated from blood cultures in our hospital, against fluconazole which
is commonly used in the treatment of systemic Candida infections. In
addition by the distribution of the accumulated isolates in the process
of the study, the most common species of Candida causes Candidemia
in our hospital were determined.
74 Candida strains (49 C. albicans, 15 C.parapsilosis, 6 C.tropicalis, 4 C.
glabrata) isolated from blood cultures (BACTEC 9000 System, Becton
Dickinson ®) sent from various clinics to Ataturk University Hospital
Medical Microbiology Laboratory between April 2012-December 2015
were included in the study. Chromogenic agar, automated VITEK
2 system (BioMerieux®, France) and if necessary the morphological
appearance on Corn Meal Agar with Tween® 80 were used to identify
Candida spp. Fluconazole susceptibility of Candida species were
determined by standard BMD method defined by CLSI and E test
method.
While 49 of the 74 isolated strains (66.2%) were albicans, 25 of them
(33.8%) were found to be non-albicans species. The most frequently
non-albicans species were C.parapsilosis (20.2%). According to the
MIC values, no fluconazole resistance was interpreted for C.albicans
and C.glabrata by both methods. However, 2 of 15 C.parapsilosis strains
were interpreted as resistant to floconazole with both methods and 2 of
6 C.tropicalis strains were interpreted as resistant with E test method.
While one of the same C.tropicalis strains was interpreted as susceptible,
the other one was interpreted as susceptible-dose dependence (S-DD)
with BMD method. According to these findings the total resistance rate
of Candida species was 5.4% by E test method while it was determined
as 2.7% in BMD method. In C.tropicalis species the result which
was resistance by E test method and sensistive by BMD method was
evaluated as “major error” (ME); the result which was resistance by E
test method and susceptible-dose dependence (S-DD) by BMD method
was evaluated as “minor error” (mE). Any “very major error” (VME)
was not found and the total agreement (EA) was calculated as 85.1%
in the study.
According to our results that can be suggested E test method can be
used as an alternative antifungal susceptibility test in routine laboratory.
However, although the E test method is easy to use and has high
reproducibility advantage compared with the BMD method, it requires
attention and experience in the application and interpretation phases of
antifungal susceptibility testing.
Anahtar Kelimeler
Kaynakça
- 1. Bassetti M, Righi E, Costa A, Fasce R, Molinari MP, Rosso R,Viscoli C. Epidemiological trends in nosocomial candidemiain intensive care. BMC Infect Dis 2006; 6: 1.
- 2. Wisplinghoff H, Bischoff T, Tallent SM, Seifert H, WenzelRP,Edmond MB. Nosocomial bloodstream infections inUS hospitals: analysis of 24,179 cases from a prospectivenationwide surveillance study. Clin Infect Dis 2004; 39: 309-17.
- 3. Yapar N. Epidemiology and risk factors for invasivecandidiasis. Ther Clin Risk Manag 2014; 10: 95-105.
- 4. Pfaller MA, Diekema DJ. Epidemiology of invasive candidiasis:a persistent public health problem. Clin Microbiol Rev 2007;20: 133-63.
- 5. Sievert DM, Rick P, Edwards JR, Schneider A, Patel J, SrinivasanA, Fridkin S. National Healthcare Safety Network (NHSN)Team and Participating NHSN Facilities. Antimicrobialresistantpathogens associated with healthcare-associatedinfections: summary of data reported to the NationalHealthcare Safety Network at the Centers for Disease Controland Prevention, 2009-2010. Infect Control Hosp Epidemiol2013; 34: 1-14.
- 6. Tortorano AM, Peman J, Bernhardt H, Klingspor L, KibblerCC, Faure O, Grillot R. Epidemiology of candidaemia inEurope: Results of 28-month European Confederation ofMedical Mycology (ECMM) hospital-based surveillancestudy. Eur J CliN MicrobioL Infect Dis 2004; 23: 317-22.
- 7. Hospenthal DR, Murray CK, Rinaldi MG. The role ofantifungal susceptibility testing in the therapy of candidiasis.Diagn Microbiol Infect Dis 2004; 48: 153-60.
- 8. Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA,Ostrosky-Zeichner L, Zaoutis TE. Clinical practice guidelinefor the management of candidiasis: 2016 update by theInfectious Diseases Society of America. Clin Infect Dis 2015;4: 933.
- 9. National Committee for Clinical Laboratory Standards(NCCLS). Performance standards for antimicrobial discsusceptibility testing; Approved Standards. NCCLS, USA.2002.
- 10. Bourgeois N, Dehandschoewercker L, Bertout S, BousquetPJ, Rispail P, Lachaud L. Antifungal susceptibility of 205Candida spp. isolated primarily during invasive candidiasisand comparison of the Vitek 2 system with the CLSI brothmicrodilution and E test methods. J Clin Microbiol 2010; 48:154-61.
- 11. Clinical and Laboratory Standards Institute (CLSI). ReferenceMethod for Broth Dilution Antifungal Susceptibility Testingof Yeasts; Approved Standard M27-A3. CLSI, Wayne PA, USA.2008.
- 12. Clinical and Laboratory Standards Institute (CLSI). ReferenceMethod for Broth Dilution Antifungal Susceptbility Testing ofYeasts; 4th Informational Supplement, M27-S4. CLSI, WaynePA, USA. 2012.
- 13. Keceli Ozcan S, Mutlu B, Dundar D, Willke A. Kankulturleinden izole edilen Candida spp. suşlarının antifungalilaclara karşı duyarlılıklarının belirlenmesinde buyyonmikrodilusyon ile E test yontemlerinin karşılaştırılması.Mikrobiyol Bul 2010; 44: 263-71.
- 14. Karakoc E, Yazgı H, Aktaş AE, Uyanık MH. Ceşitli Candidaturlerinin iki farklı triazol duyarlılıklarının mikrodilusyonyontemi ile araştırılması. Eurasian J Med 2007; 39: 177.
- 15. Alışkan HE, Bozkırlı ED, Colakoğlu Ş, Demirbilek M.Hastanemizde uc yıllık surecte kan kulturlerinden izole edilenCandida albicans ve non-albicans Candida turlerinin etkenolduğu kandidemilerdeki risk faktorlerinin irdelenmesi. TurkHijyen ve Deneysel Biyoloji Derg 2015; 73: 15-24.
- 16. Şahiner F, Ergunay K, Ozyurt M, Ardıc N, Hoşbul T,Haznedaroğlu T. Hastane enfeksiyonu etkeni olarak izoleedilen Candida suşlarının genotipik ve fenotipik olaraktanımlanması. Mikrobiyol Bul 2011; 45: 478-88.
- 17. Yılmaz G, Ciftcioğlu A, Gunduz M, Ozen M, Sarıcaoğlu EM,Akan H. Kandidemi saptanan hematolojik kanserli hastalardaetken dağılımı ve risk faktorlerinin değerlendirilmesi. KlimikDerg 2015; 28: 117-21.
- 18. Etiz P, Kibar F, Ekenoğlu Y, Yaman A. Kan kulturlerindenizole edilen Candida turlerinin dağılımının ve antifungalduyarlılıklarının retrospektif olarak değerlendirilmesi.ANKEM Derg 2015; 29: 105-13.
- 19. Montagna MT, Caggiano G, Lovero G, De Giglio O, Coretti C,Cuna T, Puntillo F. Epidemiology of invasive fungal infectionsin the intensive care unit: Results of a multicenter Italiansurvey (AURORA Project). Infection 2013; 41: 645-53.
- 20. Doi AM, Pignatari ACC, Edmond MB, Marra AR, CamargoLFA, Siqueira RA, Colombo AL. Epidemiology andmicrobiologic characterization of nosocomial candidemiafrom a Brazilian national surveillance program. PloS one2016; 11: e0146909.
- 21. Atalay MA, Sav H, Demir G, Koc AN. Kan kulturlerindenizole edilen kandida turlerinin dağılımı ve amfoterisin b veflukonazol in vitro duyarlılıkları. Selcuk Tıp Derg 2012; 28:149-51.
- 22. Sav H, Demir G, Atalay MA, Koc AN. Klinik orneklerdenizole edilen Candida turlerinin değerlendirilmesi. Turk Hijyenve Deneysel Biyoloji Derg 2013; 70: 175-80.
- 23. Lee MK, Williams LE, Warnock DW, Arthington-Skaggs BA.Drug resistance genes and trailing growth in Candida albicansisolates. J Antimicrob Chemother 2004; 53: 217-24.
- 24. Menezes EA, Vasconcelos Junior AAD, Angelo MRF, CunhaMDCDS, Cunha FA. Correlation between microdilution, Etest, and disk diffusion methods for antifungal susceptibilitytesting of fluconazole against Candida sp. blood isolates. RevSoc Bras Med Trop 2013; 46: 106-7.
- 25. Matar MJ, Ostrosky-Zeichner L, Paetznick VL, Rodriguez JR,Chen E, Rex JH. Correlation between E-test, disk diffusion,and microdilution methods for antifungal susceptibilitytesting of fluconazole and voriconazole. Antimicrob AgentsChem 2003; 47: 1647-51.
- 26. Pfaller MA, Espinel-Ingroff A, Boyken L, Hollis RJ, KroegerJ, Messer SA, Diekema DJ. Comparison of the brothmicrodilution (BMD) method of the European Committee onAntimicrobial Susceptibility Testing with the 24-hour CLSIBMD method for testing susceptibility of Candida speciesto fluconazole, posaconazole, and voriconazole by use ofepidemiological cutoff values. J Clin Microbiol 2011; 49: 845-50.
- 27. Arikan S, Gur D, Akova M. Comparison of E test,microdilution and colorimetric dilution with referencebroth macrodilution method for antifungal susceptibilitytesting of clinically significant Candida species isolated fromimmunocompromised patients. Mycoses 1997; 40: 291-6.
- 28. Kоc AN, Gokahmetoglu S, Oguzkaya M. Antifungalsusceptibility testing of yeasts with broth microdilution andE-test methods. ANKEM Derg 1998; 12: 497-502.
- 29. Kоc AN, Gokahmetoglu S, Oguzkaya M. Comparison of E testwith the broth microdilution method in susceptibility testingof yeast isolates against four antifungals. Mycoses 2000; 43:293-7.
- 30. Yucesoy M, Mutlu E, Yuluğ N. Antifungal duyarlılığınsaptanmasında E test yonteminin değerlendirilmesi. ANKEM Derg 2001; 15: 670-7.
- 31. Evci C, Ener B, Goral G, Akcağlar S. Comparative evaluationof the antifungal susceptibility of Candida isolates from bloodspecimens: results of a study in a tertiary care hospital inBursa, Turkey. Turk J Med Sci 2010; 40: 141-9.
- 32. Jaruvongvanich V. Correlation between broth microdilution,E-test and disk diffusion methods for testing antifungalsusceptibility of Candida species isolated from Thai bloodsamples. Asian Biomed 2016; 75.
- 33. Barry AL, Pfaller MA, Rennie RP, Fuchs PC, Brown SD.Precision and accuracy of fluconazole susceptibility testingby broth microdilution, E test, and disk diffusion methods.Antimicrob Agents Chemother 2002; 46: 1781-4.
- 34. Maxwell MJ, Messer SA, Hollis RJ, Boyken L, Tendolkar S,Diekema DJ, International Fungal Surveillance ParticipantGroup. Evaluation of E test method for determiningfluconazole and voriconazole MICs for 279 clinical isolatesof Candida species infrequently isolated from blood. J ClinMicrobiol 2003; 41: 1087-90.
Kan Kültürlerinden İzole Edilen Candida Türlerinin Flukonazol E Test Duyarlılıklarının CLSI Referans Mikrodilusyon Yöntemi ile Karşılaştırılması
Öz
Özellikle invaziv Candida enfeksiyonu etkeni izolatlar için duyarlılık testi
yapılması son yıllarda antifungal ajanlara karşı artış gösteren dirençle
birlikte büyük bir önem taşımaktadır. Ancak antifungal duyarlılık
testi olarak “Clinical and Laboratory Standards Institute (CLSI)”
tarafından standardize edilen sıvı mikrodilüsyon yönteminin (Broth
Mikrodilüsyon; BMD) uygulanmasındaki zorluklar araştırmacıları
rutin laboratuvarda kullanılabilecek daha pratik yöntem arayışına
itmektedir. Bu çalışmanın amacı hastanemizde kan kültürlerinden
izole edilen Candida izolatlarında, sistemik Candida enfeksiyonlarının
tedavisinde sıklıkla kullanılan bir ajan olan flukonazole karşı
duyarlılığın belirlenmesinde E test yönteminin standart BMD yöntemi
ile karşılaştırılması amaçlanmıştır. Ayrıca çalışma süreci içerisinde
biriktirilen izolatların tiplendirilmesi ile hastanemizde en sık kandidemi
etkeni olan Candida türlerinin oranı da belirlenmiştir.
Çalışmaya Atatürk Üniversitesi Hastanesi Tıbbi Mikrobiyoloji
Laboratuvarı’na Nisan 2012-Aralık 2015 tarihleri arasında çeşitli
kliniklerden gönderilen kan kültürlerinden (BACTEC 9000 Sistemi;
Becton Dickinson®) izole edilen 74 Candida izolatı (49 adet C. albicans,
15 adet C. parapsilosis, 6 adet C. tropicalis, 4 adet C. glabrata) dahil
edilmiştir. Candida türlerini tanımlamak için kromojenik agar ve
VITEK 2 otomatize sisteminin (BioMerieux®,Fransa) ilgili tiplendirme
kartları kullanılmış, gerekli olması durumunda suşların mısır unlu
Tween 80 agar besiyerinde morfolojik görünümlerine bakılmıştır.
Candida türlerinin flukonazol duyarlılıkları CLSI tarafından tanımlanan
standart BMD yöntemi ve E test yöntemi ile incelenmiştir.
Çalışmaya dahil edilen 74 izolatın 49’nun (%66.2) albicans ve 25’inin
ise (%33.8) albicans dışı türler olduğu görülmüştür. En sık izole edilen
albicans dışı türün C.parapsilosis (%20.2) olduğu tespit edilmiştir.
MİK değerlerine göre C.albicans ve C.glabrata izolatlarında her iki
yöntemle de flukonazol direncine rastlanmamıştır. Bununla birlikte
15 C.parapsilosis izolatının 2’si her iki yöntemle flokonazole dirençli
olarak gözlenirken; 6 C.tropicalis izolatından 2’si E test yöntemi ile
dirençli olarak yorumlanmıştır. BMD yöntemi ile ise aynı C.tropicalis
izolatlarından biri duyarlı diğeri ise doz bağımlı duyarlı (S-DD) olarak
tespit edildi. Buna göre Candida türlerinde toplam direnç oranı E
test yöntemi ile %5.4 iken bu oran BMD yönteminde %2.7 olarak
belirlenmiştir. C.tropicalis türlerinde E test yöntemi ile dirençli BMD
yöntemi ile duyarlı olan sonuç “büyük hata” (ME); E test yöntemi ile
dirençli BMD yöntemi ile doz bağımlı duyarlı (S-DD) olan sonuç ise
“küçük hata” (mE) şeklinde değerlendirilmiştir. Candida türlerinde E
test ile flukonazol duyarlılığı bakılmasında “çok büyük hata”ya (VME)
rastlanmamış, toplam uyum (EA) %85.1 olarak hesaplanmıştır.
Elde ettiğimiz veriler E test yönteminin rutin laboratuvarda
Candida türleri için alternatif bir antifungal duyarlılık testi olarak
kullanılabileceğini işaret etmektedir. Bununla birlikte her ne kadar
E test yöntemi, BMD yöntemine göre kolay kullanıma sahip olması,
tekrarlanabilirliğinin yüksek olması avantajlarını taşısa da, antifungal
duyarlılık testi olarak kullanılırken uygulama ve yorumlama
aşamalarında dikkat ve deneyim gerektirmektedir.
Anahtar Kelimeler
Kaynakça
- 1. Bassetti M, Righi E, Costa A, Fasce R, Molinari MP, Rosso R,Viscoli C. Epidemiological trends in nosocomial candidemiain intensive care. BMC Infect Dis 2006; 6: 1.
- 2. Wisplinghoff H, Bischoff T, Tallent SM, Seifert H, WenzelRP,Edmond MB. Nosocomial bloodstream infections inUS hospitals: analysis of 24,179 cases from a prospectivenationwide surveillance study. Clin Infect Dis 2004; 39: 309-17.
- 3. Yapar N. Epidemiology and risk factors for invasivecandidiasis. Ther Clin Risk Manag 2014; 10: 95-105.
- 4. Pfaller MA, Diekema DJ. Epidemiology of invasive candidiasis:a persistent public health problem. Clin Microbiol Rev 2007;20: 133-63.
- 5. Sievert DM, Rick P, Edwards JR, Schneider A, Patel J, SrinivasanA, Fridkin S. National Healthcare Safety Network (NHSN)Team and Participating NHSN Facilities. Antimicrobialresistantpathogens associated with healthcare-associatedinfections: summary of data reported to the NationalHealthcare Safety Network at the Centers for Disease Controland Prevention, 2009-2010. Infect Control Hosp Epidemiol2013; 34: 1-14.
- 6. Tortorano AM, Peman J, Bernhardt H, Klingspor L, KibblerCC, Faure O, Grillot R. Epidemiology of candidaemia inEurope: Results of 28-month European Confederation ofMedical Mycology (ECMM) hospital-based surveillancestudy. Eur J CliN MicrobioL Infect Dis 2004; 23: 317-22.
- 7. Hospenthal DR, Murray CK, Rinaldi MG. The role ofantifungal susceptibility testing in the therapy of candidiasis.Diagn Microbiol Infect Dis 2004; 48: 153-60.
- 8. Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA,Ostrosky-Zeichner L, Zaoutis TE. Clinical practice guidelinefor the management of candidiasis: 2016 update by theInfectious Diseases Society of America. Clin Infect Dis 2015;4: 933.
- 9. National Committee for Clinical Laboratory Standards(NCCLS). Performance standards for antimicrobial discsusceptibility testing; Approved Standards. NCCLS, USA.2002.
- 10. Bourgeois N, Dehandschoewercker L, Bertout S, BousquetPJ, Rispail P, Lachaud L. Antifungal susceptibility of 205Candida spp. isolated primarily during invasive candidiasisand comparison of the Vitek 2 system with the CLSI brothmicrodilution and E test methods. J Clin Microbiol 2010; 48:154-61.
- 11. Clinical and Laboratory Standards Institute (CLSI). ReferenceMethod for Broth Dilution Antifungal Susceptibility Testingof Yeasts; Approved Standard M27-A3. CLSI, Wayne PA, USA.2008.
- 12. Clinical and Laboratory Standards Institute (CLSI). ReferenceMethod for Broth Dilution Antifungal Susceptbility Testing ofYeasts; 4th Informational Supplement, M27-S4. CLSI, WaynePA, USA. 2012.
- 13. Keceli Ozcan S, Mutlu B, Dundar D, Willke A. Kankulturleinden izole edilen Candida spp. suşlarının antifungalilaclara karşı duyarlılıklarının belirlenmesinde buyyonmikrodilusyon ile E test yontemlerinin karşılaştırılması.Mikrobiyol Bul 2010; 44: 263-71.
- 14. Karakoc E, Yazgı H, Aktaş AE, Uyanık MH. Ceşitli Candidaturlerinin iki farklı triazol duyarlılıklarının mikrodilusyonyontemi ile araştırılması. Eurasian J Med 2007; 39: 177.
- 15. Alışkan HE, Bozkırlı ED, Colakoğlu Ş, Demirbilek M.Hastanemizde uc yıllık surecte kan kulturlerinden izole edilenCandida albicans ve non-albicans Candida turlerinin etkenolduğu kandidemilerdeki risk faktorlerinin irdelenmesi. TurkHijyen ve Deneysel Biyoloji Derg 2015; 73: 15-24.
- 16. Şahiner F, Ergunay K, Ozyurt M, Ardıc N, Hoşbul T,Haznedaroğlu T. Hastane enfeksiyonu etkeni olarak izoleedilen Candida suşlarının genotipik ve fenotipik olaraktanımlanması. Mikrobiyol Bul 2011; 45: 478-88.
- 17. Yılmaz G, Ciftcioğlu A, Gunduz M, Ozen M, Sarıcaoğlu EM,Akan H. Kandidemi saptanan hematolojik kanserli hastalardaetken dağılımı ve risk faktorlerinin değerlendirilmesi. KlimikDerg 2015; 28: 117-21.
- 18. Etiz P, Kibar F, Ekenoğlu Y, Yaman A. Kan kulturlerindenizole edilen Candida turlerinin dağılımının ve antifungalduyarlılıklarının retrospektif olarak değerlendirilmesi.ANKEM Derg 2015; 29: 105-13.
- 19. Montagna MT, Caggiano G, Lovero G, De Giglio O, Coretti C,Cuna T, Puntillo F. Epidemiology of invasive fungal infectionsin the intensive care unit: Results of a multicenter Italiansurvey (AURORA Project). Infection 2013; 41: 645-53.
- 20. Doi AM, Pignatari ACC, Edmond MB, Marra AR, CamargoLFA, Siqueira RA, Colombo AL. Epidemiology andmicrobiologic characterization of nosocomial candidemiafrom a Brazilian national surveillance program. PloS one2016; 11: e0146909.
- 21. Atalay MA, Sav H, Demir G, Koc AN. Kan kulturlerindenizole edilen kandida turlerinin dağılımı ve amfoterisin b veflukonazol in vitro duyarlılıkları. Selcuk Tıp Derg 2012; 28:149-51.
- 22. Sav H, Demir G, Atalay MA, Koc AN. Klinik orneklerdenizole edilen Candida turlerinin değerlendirilmesi. Turk Hijyenve Deneysel Biyoloji Derg 2013; 70: 175-80.
- 23. Lee MK, Williams LE, Warnock DW, Arthington-Skaggs BA.Drug resistance genes and trailing growth in Candida albicansisolates. J Antimicrob Chemother 2004; 53: 217-24.
- 24. Menezes EA, Vasconcelos Junior AAD, Angelo MRF, CunhaMDCDS, Cunha FA. Correlation between microdilution, Etest, and disk diffusion methods for antifungal susceptibilitytesting of fluconazole against Candida sp. blood isolates. RevSoc Bras Med Trop 2013; 46: 106-7.
- 25. Matar MJ, Ostrosky-Zeichner L, Paetznick VL, Rodriguez JR,Chen E, Rex JH. Correlation between E-test, disk diffusion,and microdilution methods for antifungal susceptibilitytesting of fluconazole and voriconazole. Antimicrob AgentsChem 2003; 47: 1647-51.
- 26. Pfaller MA, Espinel-Ingroff A, Boyken L, Hollis RJ, KroegerJ, Messer SA, Diekema DJ. Comparison of the brothmicrodilution (BMD) method of the European Committee onAntimicrobial Susceptibility Testing with the 24-hour CLSIBMD method for testing susceptibility of Candida speciesto fluconazole, posaconazole, and voriconazole by use ofepidemiological cutoff values. J Clin Microbiol 2011; 49: 845-50.
- 27. Arikan S, Gur D, Akova M. Comparison of E test,microdilution and colorimetric dilution with referencebroth macrodilution method for antifungal susceptibilitytesting of clinically significant Candida species isolated fromimmunocompromised patients. Mycoses 1997; 40: 291-6.
- 28. Kоc AN, Gokahmetoglu S, Oguzkaya M. Antifungalsusceptibility testing of yeasts with broth microdilution andE-test methods. ANKEM Derg 1998; 12: 497-502.
- 29. Kоc AN, Gokahmetoglu S, Oguzkaya M. Comparison of E testwith the broth microdilution method in susceptibility testingof yeast isolates against four antifungals. Mycoses 2000; 43:293-7.
- 30. Yucesoy M, Mutlu E, Yuluğ N. Antifungal duyarlılığınsaptanmasında E test yonteminin değerlendirilmesi. ANKEM Derg 2001; 15: 670-7.
- 31. Evci C, Ener B, Goral G, Akcağlar S. Comparative evaluationof the antifungal susceptibility of Candida isolates from bloodspecimens: results of a study in a tertiary care hospital inBursa, Turkey. Turk J Med Sci 2010; 40: 141-9.
- 32. Jaruvongvanich V. Correlation between broth microdilution,E-test and disk diffusion methods for testing antifungalsusceptibility of Candida species isolated from Thai bloodsamples. Asian Biomed 2016; 75.
- 33. Barry AL, Pfaller MA, Rennie RP, Fuchs PC, Brown SD.Precision and accuracy of fluconazole susceptibility testingby broth microdilution, E test, and disk diffusion methods.Antimicrob Agents Chemother 2002; 46: 1781-4.
- 34. Maxwell MJ, Messer SA, Hollis RJ, Boyken L, Tendolkar S,Diekema DJ, International Fungal Surveillance ParticipantGroup. Evaluation of E test method for determiningfluconazole and voriconazole MICs for 279 clinical isolatesof Candida species infrequently isolated from blood. J ClinMicrobiol 2003; 41: 1087-90.
Toplam 34 adet kaynakça vardır.
Ayrıntılar
| Konular | Sağlık Kurumları Yönetimi |
|---|---|
| Bölüm | Makaleler |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Nisan 2017 |
| Yayımlandığı Sayı | Yıl 2017 Cilt: 21 Sayı: 2 |