临床常见念珠菌对四种抗真菌药物体外敏感性研究

In vitro susceptibility of Candida spp. to four antifungal agents

目的:了解临床常见致病念珠菌对4种抗真菌药物的敏感性情况,旨在为临床治疗此类菌株引起的感染提供实验依据。方法:采用美国国家临床实验室标准化委员会推荐的微量肉汤稀释法(NCCLS M27-A2),测定从临床血液、痰液和尿液等标本中分离的226株常见念珠菌对氟康唑、伊曲康唑、两性霉素B和氟胞嘧啶的最低抑菌浓度(MIC)。结果:226株受试菌对氟胞嘧啶100%敏感,MIC_(90)为≤0.125～0.5μg/ml;168株白色念珠菌对氟康唑、伊曲康唑和两性霉素B的MIC_(90)分别为32μg/ml、1μg/ml和1μg/ml,敏感率分别为90.5%(S88.1%+SDD2.4%)、92.3%(S87.5%+SDD4.8%)和91.7%;31株热带念珠菌对氟康唑、伊曲康唑和两性霉素B敏感率分别为96.8%(S93.6%+SDD3.2%)、93.5%(S83.9%+SDD9.6%)和100%;16株近平滑念珠菌对氟康唑、伊曲康唑和两性霉素B均敏感;11株光滑念珠菌对氟康唑和伊曲康唑的敏感率分别为81.8%(S18.2%+SDD63.6%)和72.8%(S36.4%+SDD36.4%),而对两性霉素B100%敏感。在白色念珠菌、热带念珠菌和光滑念珠菌中有3.2%～27.2%菌株对氟康唑和伊曲康唑等唑类药物耐药。结论:临床常见致病念珠菌对氟胞嘧啶和两性霉素B的敏感性最高,对唑类药物存在不同程度耐药。

objective: To study the susceptibility of clinical isolates of Candida spp. to four antifungal agents, in order to provide the proofs for clinically selecting antifungal agents and effectively controlling candida infections. Methods: the minimal inhibitory concentrations (MIC) of fluconazole (FCZ)、itraconazole (ICE)、amphotericin (AMB) and flucytosine (5-FC) against 226 clinical isolates Candida spp. obtained from like bloodsputum and urine were determined by broth microdilution tests performed according to the National Committee for Clinical Laboratory Standards guideline (NCCLS M27-A2) dy using RPMI1640 as the test medium. Results: 226 Candida isolates were susceptible to 5-FC, the MIC_(90) is below 0.125～0.5μg/ml. The MIC_(90) of FCZ、ICZ and AMB against 168 isolates of Candida albicans were 32μg/ml、1μg/ml and 1μg/ml, respectively, the rates of susceptibility were 90.5% (S88.1%+SSD2.4%)、92.3% (S87.5%+SSD4.8%)and 91.7% respectively; the rates of susceptibility of 31isolates of Candida tropiclis to FCZ ICZ and AMB were 96.8% (S93.6%+SDD3.2%)、93.5%(S83.9%+SDD9.6%)and 100%, respectively. 16 isolates of Candida parapsilosis were all susceptible to FCZ、ICZ and AMB. the rates of susceptibility of 11 Candida glabrate isolates to FCZ and ICZ were 81.8%(S18.2%+SDD63.6%)and 72.8%(S36.4%+SDD36.4%), respectively, while 100% susceptibility to AMB. 3.2%～27.2% isolates of Candida albicans, Candida tropicalis and Candida glabrate were resistant to triazole antifungal drugs (FCZ and ICZ). Conclutions: The susceptibility of all clinical isolates to 5-FC and AMB are the best. There are the resistance to triazole antifugal drugs.