Published Ahead of Print 10 March 2010.

10.1128/JCM.01814-09.
2010, 48(5):1924. DOI: J. Clin. Microbiol.
Davise H. Larone
Theresa Scognamiglio, Riva Zinchuk, Pramod Gumpeni and

Medium for Isolation of Fungi

Sabouraud Dextrose Agar as a Primary
Comparison of Inhibitory Mold Agar to
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JOURNAL OF CLINICAL MICROBIOLOGY, May 2010, p. 19241925 Vol. 48, No. 5
0095-1137/10/$12.00 doi:10.1128/JCM.01814-09
Copyright 2010, American Society for Microbiology. All Rights Reserved.
Comparison of Inhibitory Mold Agar to Sabouraud Dextrose
Agar as a Primary Medium for Isolation of Fungi

Theresa Scognamiglio,* Riva Zinchuk, Pramod Gumpeni, and Davise H. Larone

Department of Pathology and Laboratory Medicine, Weill Cornell Center, NewYork-Presbyterian Hospital, New York, New York
Received 15 September 2009/Returned for modication 9 November 2009/Accepted 2 March 2010
Clinical specimens cultured on two selective fungal media, inhibitory mold agar (IMA) and Sabouraud
dextrose agar (SDA), were compared with respect to recovery of fungi. Of the 840 fungal isolates recovered,
69.3% grew on both IMA and SDA; 24.9% grew only on IMA; and 5.8% grew only on SDA, showing that IMA
is superior (P 0.003).
Fungal infections have become increasingly more common,
especially in the setting of immunocompromised patients (1, 5,
6). In order to correctly diagnose and appropriately treat these
infections, it is imperative rst that the etiologic agent be
grown and isolated on culture; only after that can the organism
be identied and the most proper treatment be ensured. It is
therefore essential that effective media, selective for fungi, be
utilized for all fungal cultures (3, 7, 8, 10). The battery of
primary media in many labs routinely includes the following:
(i) one medium containing no antimicrobial agents, (ii) one
medium containing an antibiotic(s) (commonly chloramphen-
icol and/or gentamicin) to prevent the growth of bacteria, (iii)
one medium containing an antibiotic and additionally cyclo-
heximide to inhibit the growth of rapidly growing fungi that
may be saprobic and able to overgrow a slower growing patho-
genic fungus, and (iv) an enriched medium, when a fastidious
thermally dimorphic fungus is a possibility, to ensure its growth
(4, 11).
Sabouraud dextrose agar (SDA), the original formulation or
the Emmons modication, without any antibiotic has histori-
cally been used as the standard medium for the primary isola-
tion of fungus and is still widely used (2, 7, 8). Inhibitory mold
agar (IMA) is an enriched medium containing chlorampheni-
col (with some formulations containing gentamicin) and, in
recent years, has become more commonly used as a major
primary medium. It supports the growth of a wide range of
fungi and, due to its antibiotic content, may inhibit bacterial
growth more effectively than does Emmons SDA. As cost con-
tainment has become a key issue, many laboratories today are
attempting to responsibly reduce the types of agar used in their
primary fungal medium battery. It is not unusual for a labora-
tory to rely solely on SDA as its main cycloheximide-free me-
dium or to include both SDA and IMA in their primary bat-
tery. The purpose of this study was to compare Emmons SDA
to IMA and determine the more effective primary medium.
Clinical specimens submitted for fungal cultures in our in-
stitution over a 3-year period were included in this study.
Specimens were cultured from various sites (respiratory, urine,
genital, skin, nails, wound, tissue, cerebrospinal uid [CSF],
blood). The specimens were inoculated onto IMA, Emmons
SDA, and Mycosel agar (Becton Dickinson, Cockeysville, MD).
The cultures were incubated at 30C for a maximum of 4
weeks. Fungal colonies on each agar were semiquantitatively
assessed and recorded as no growth, sparse, few, moderate, or
many. Cultures that yielded sparse growth on one medium and
no growth on the remaining media were excluded from the
study due to possibility of random sampling error. Mycosel,
which contains chloramphenicol and cycloheximide, was ex-
cluded from this comparative analysis, as its function is differ-
ent and it would be required regardless of whether SDA or
IMA was the other medium utilized. All isolates were subse-
quently identied, and the data were tabulated and categorized
according to the type of fungus grown. Data were analyzed
using Excel and SPSS 11.0, and statistical analysis was per-
formed using a Fisher exact t test.
A total of 840 fungal isolates were recovered and identied,
representing 49 fungal species. Of those 840, 69.3% grew on
both IMA and SDA, 24.9% grew only on IMA, and 5.8% grew
only on SDA (Table 1). Overall, 94.2% of the isolates were
recovered on IMA, while 75.1% of the isolates were recovered
on SDA. There was no difference in the time to recovery of the
isolates on IMA versus SDA. When considering the organisms
that grew only on one of the two media, IMA supported the
growth of four times more isolates than did SDA. Five of the
six categories of fungus were signicantly better supported by
IMA than by SDA (Table 1). Two of the six categories of
fungus (yeast and hyaline hyphomycetes) showed an exception-
ally large statistically signicant difference (P 0.00013) in
favor of IMA (Table 1). Notably, almost 50% of the dermato-
phytes did not grow on SDA (Table 1). SDA did not show a
statistical advantage for any of the six categories of fungus.
Outstanding differences in growth were noted among several
fungal species (Table 2). Although none of the fungal isolates
showed statistically signicant recovery on SDA over IMA, it
must be noted that a considerable percentage of isolates
among a few genera grew on SDA only. This was seen in some
of the hyaline hyphomycetes (Table 3) and in the Rhodotorula
spp. (Table 2). Reports have suggested that chloramphenicol
adversely affects Rhodotorula (9, 12). Therefore, in the in-
stance of a low inoculum, the use of IMA, without an antibi-
otic-free medium included in the battery, may result in a de-
* Corresponding author. Mailing address: Department of Pathology
and Laboratory Medicine, Weill Cornell Medical Center, 525 East
68th Street-Starr 1031A, New York, NY 10065. Phone: (212) 746-6398.
Fax: (212) 746-8624. E-mail: ths9004@med.cornell.edu.

Published ahead of print on 10 March 2010.

1924

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creased recovery of these organisms. Too few cultures grew
thermally dimorphic fungi to determine a medium preference
for this category.
In comparing IMA to SDA as the routine cycloheximide-
free medium for the primary isolation of fungi, IMA is superior
to SDA, as it will recover signicantly more isolates than will
SDA (P 0.003). However, SDA continues to have a role in
the laboratorys regimen, as Nocardia (a lamentous bacterium
that may be screened for in the mycology laboratory) requires
an antibiotic-free medium and grows well on SDA. Addition-
ally, there are a relatively low but noticeable number of isolates
of Rhodotorula spp. and hyaline hyphomycetes that may grow
on SDA and not IMA.
The results of this study indicate that SDA should not be
used without accompaniment by IMA or another proven sup-
portive fungal medium.
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French.)
TABLE 1. Comparison of primary growth on IMA versus SDA
Category of
fungus
No. of
isolates
% of isolates with
growth on: Statistical
signicance
(P value)
a
IMA and
SDA
IMA
only
SDA
only
Yeast 578 74.4 20.2 5.4 0.00013
Hyaline hyphomycetes 143 64.3 24.5 11.2 0.00014
Dermatophytes 94 48.9 48.9 2.1 0.001
Dematiaceous fungi 12 58.3 41.7 0.0 0.001
Zygomycetes 9 33.3 66.7 0.0 0.001
Thermally dimorphic
b
4 100.0 0.0 0.0 NS
Total 840 69.3 24.9 5.8 0.003
a
IMA versus SDA. NS, not signicant.
b
All four isolates were H. capsulatum.
TABLE 2. Fungi with outstanding growth differences
on IMA versus SDA
Fungus
No. of
isolates
% of isolates with growth on:
IMA and
SDA
IMA only SDA only
Penicillium 20 35.0 60.0 5.0
Trichophyton rubrum 17 41.2 58.8 0.0
Trichophyton tonsurans 68 52.9 45.6 1.5
Candida parapsilosis 39 51.2 48.7 0.0
Candida glabrata 37 75.6 21.6 2.7
Candida albicans 321 82.2 13.7 4.0
Rhodotorula
a
34 38.2 44.1 17.6
a
The only yeast showing a noticeable number of isolates with growth on SDA
only.
TABLE 3. Hyaline hyphomycete growth on SDA versus IMA
Fungus
No. of
isolates
% of isolates with growth on:
IMA and
SDA
IMA only SDA only
Trichoderma 3 33 33 33
Aspergillus niger 19 47 32 21
Aspergillus NOS
a
22 64 18 18
Aspergillus fumigatus 35 69 17 14
Fusarium 8 50 38 12
Aspergillus avus 28 93 0 7
Penicillium 20 35 60 5
Arthrographis 1 0 100 0
Aspergillus terreus 1 100 0 0
Aspergillus versicolor 2 100 0 0
Paecilomyces 1 100 0 0
Acremonium 2 100 0 0
Scopulariopsis 1 100 0 0
a
NOS, not otherwise specied.
VOL. 48, 2010 NOTES 1925

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