In vitro activity of Caspofungin combined with Fluconazole on mixed Candida albicans and Candida glabrata biofilm

The objective of this study was to evaluate the antifungal effect of caspofungin (CAS) combined with fluconazole (FLU) on the biofilm biomass and cultivable viability and microstructure of Candida albicans and Candida glabrata mixed biofilm in vitro. Biofilms were formed in a 96-well microtiter plate for crystal violet assay and colony forming unit (CFU) method and grown on plastic coverslip disks for scanning electron microscopy. MIC50 of CAS and FLU against single Candida spp. and mixed Candida spp. biofilms were evaluated using crystal violet assay. Additional, C. albicans and C. glabrata mixed biofilms were incubated with subinhibitory CAS concentration plus FLU and their percentages of Candida biofilm reduction were calculated. We found that percentages of biofilm reduction were significantly decreased when CAS at 0.25MIC and FLU (0.25 or 0.5MIC) were combined (P < .05) but not different when CAS at 0.5 MIC combined with FLU at 0.25 or 0.5MIC, compared to CAS treatment alone. Structural analyses revealed that CAS/FLU combination-treated biofilms showed less hyphae and blastospores with some aberrant cells compared to control group. Although it was evident that a greater CFU of Candida glabrata were demonstrated in every group, the total viable cells derived from CAS/FLU combination-treated biofilms at any ratio were not significantly different from positive control. Overall, CAS/FLU combinations appeared to affect the quantity and cell architecture, but number of viable cell, of Candida albicans and Candida glabrata mixed biofilm. This antifungal effect was CAS concentration dependent.