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Antifungal susceptibility testing has become an important tool for physicians faced with making difficult treatment decisions regarding treatment of patients with fungal infections. The Clinical Laboratory and Standards Institute (CLSI) has approved methods for testing of both yeast and moulds. Antifungal susceptibility testing of Candidahas been standardized and refined and now may play a useful role in managing Candidainfections. Important new developments include validation of 24-h reading times for all antifungal agents and the establishment of species-specific epidemiological cutoff values (ECVs) for the systemically active antifungal agents and both common and uncommon species ofCandida. Standardization of in vitro susceptibility tests by the Clinical and Laboratory Standards Institute (CLSI) and the European Committee for Antimicrobial Susceptibility Testing (EUCAST), and current availability of reference methods constituted the major remarkable steps in the field. We reviewed our antifungal susceptibility data for capsofungin, anidulafungin, voriconazole and posaconazole against Candida species and compared susceptibility patterns determined by the previous and recently revised CLSI antifungal breakpoints. With the new breakpoints, all C. albicans isolates and C.tropicalis were classified as susceptible to anidulafungin on MHA and while showed 63% and 66% of susceptibility on RPMI repectively according to revised CLSI M27 S4 breakpoints, whereas (36%) and (33%) of C. albicans and C.tropicalis isolates were found under susceptible dose dependent category on RPMI respectively. For capsofungin all, eleven (100%) C.albicans and three (100%) C.tropicalis were found to be susceptible on both the media and none of the tested isolates was categorized under resistance category. For posaconazole all eleven (100%) C.albicans were found to be susceptible on MHA media and none of the tested isolates was categorized under resistance category, although 54% were determined to show susceptibility and 45% showed resistance on RPMI to posaconazole. All the isolates that showed resistance to voriconazole were found to be susceptible to posaconazole. Among all four drugs activity were analysed by ANOVA: Single factor and students‘t’ test Two-Sample Assuming Equal Variances was found to that capsofungin >anadulafungin>posaconazole >voriconazole aganist all 14 Candida isolates. Results obtained by the E-test method shows a > 71% correlation with those obtained by the AFST-EUCAST method. The agar-based E-test has been proposed as a more sensitive technology to discriminate strains of Candida species the role of microdilution methods seems to be restricted to reference laboratories because they are laborious. In addition, the micro broth format is not commonly used in clinical laboratories Disk and strip diffusion methodologies are simple, rapid, cost-effective and produce similar results to the reference methods for yeasts.The studies included in this thesis have contributed significantly to the understanding of the interplay between the Candida virulence, epidemiology and susceptibility and the importance of appropriate diagnostics and treatment choice.

In vitro Antifungal Susceptibility Proﬁles of Echinocandins and Triazoles for Clinical Opportunistic Candida isolates by E-test method