眼部主要感染真菌对两性霉素B和氟康唑的敏感度

The medicinal hypersensitivity of amphotericin B and fluconazole to the most common ocular fungi

目的探讨两性霉素B(amphotericin B)和氟康唑(fluconazole)这两种常见的抗真菌药物对眼科常见的致病真菌(镰刀菌属、念珠菌属、曲霉菌属)的体外抗菌活性。方法经刮片收集的眼部真菌感染58例。将标本接种于Sabouraud培养基中分离培养,阳性菌株42例。根据真菌培养的形态学特征和糖发酵、糖同化及硝酸盐还原试验,分离鉴定出镰刀菌属14例,念珠菌属14例,曲霉菌属9例,其他5例。共对37例这3株眼部体外培养真菌进行研究,ampho-tericin B和fluconazole体外单独用药时,用NCCLS推荐使用常量肉汤稀释法(M27-A,1997)进行真菌的药敏试验。分析方法采用t检验。结果Amphotericin B对镰刀菌属的最小抑菌浓度(MIC)50为0.55μg/ml,MIC90为2.50μg/ml;对念珠菌属的MIC50为0.68μg/ml,MIC90为2.90μg/ml;对曲霉菌属的MIC50为2.50μg/ml,MIC90为4.36μg/ml。而flucona-zole对镰刀菌属和念珠菌属的MIC≥128μg/ml;对曲霉菌属的MIC50为1.32μg/ml,MIC90为2.68μg/ml。结论Amphotericin B对镰刀菌属和念珠菌属均有明显的体外抗菌活性(MIC<8μg/ml),而fluconazole对曲霉菌属的抗菌活性高于amphotericin B,治疗眼部曲霉菌属感染应首选fluconazole。

Objective To study in vitro the antibiotic sensitivity of amphotericin B and fluconazole, which are commonly used to treat fungal corneal ulcers caused by Fusarium, Candida and Aspergillus. Methods Fifty-eight samples were collected by scraping fram fungal corneal ulcers in the Wenzhou region between Sep. 2003 and June 2005. The samples were innoarlated an a Sabourand culture medium and 42 positive cases were cultivated. Following procedures in morphology, sugar fermentation, sugar assinfihtion and nitrate reduction tests were used to isolate and identify 14 cases of Fusarium, 14 cases of Candida, 9 cases of Aspergillus and 5 other cases. These 37 positive cases were investigated by using amphotericin B and fluconazole in vitro, fol- lowing the fungal medicinal hypersenstivity experiment in M27-A, 1997, that has been recommended by NCCLS. A t-test analysis was used for this experi ment.Results Minimam inhibition concentration （MIC）50 of amphotericin B anti-Fusmium was 0.55 μg/ml and MIC90 was 2.50 μg/ml; MIC50 of amphotericin B anti-Candiada was 0.68 μg/ml and MIC90 was 2.90 μg/ml; MIC50 of amphotericin B anfi-Aspergillus was 2.50 μg/ml and MIC90 was 4.36 μg/ml; MIC d fluconazole anti-Fusarium and Candida was ≥ 128 μg/ ml; and anti-Aspergillus MIC50 was 1.32 μg/ml and MIC90 was 2.68 μg/ ml. Conclusion Amphotericin B has an obvious sensitivity in vitro anti- Fusarium and anti-Candida （MIC 〈 8 μg/ml）, but the anti-Aspergillus sensisvity of fluconazole is high than amphotericin B, so fluconezole is the fast choice in treating fungal corneal ulcers caused by Aspergillus.