中国5所医院念珠菌属对氟康唑和伏立康唑的耐药性监测

Surveillance of resistance to fluconazole and voriconazole in Candida isolates from 5 hospitals in China

目的了解临床分离念珠菌属和其他酵母对氟康唑和伏立康唑的耐药性及耐药性变迁。方法按CLSI/NCCLS M44-A推荐的纸片扩散法对2001年至2005年8 000株念珠菌属和其他酵母临床分离株进行氟康唑和伏立康唑的药敏试验;并通过BIOMIC软件换算出相应的MIC(mg/L)。结果白念珠菌及非白念珠菌如光滑念珠菌等在临床分离真菌中的分布自2001—2005年未见有明显的上升趋势。2001—2005年白念珠菌对氟康唑和伏立康唑的耐药率变化不大,但光滑念珠菌等非白念珠菌对氟康唑和伏立康唑的耐药率有不同程度的上升。结论伏立康唑较氟康唑具有更广的抗菌谱和更强的抗菌活性;光滑念珠菌等非白念珠菌的耐药率正在逐年上升;提示对念珠菌属开展耐药性监测的重要性。

Objective To investigate the situation and change of antifungal resistance in clinical Candida and other fungal isolates from 5 hospitals in diverse geographic region of China. Methods Antimicrobial susceptibility testing of 8 000 fungal isolates collected during 2001 and 2005 were carried out with 25 μg fluconazole disk and 1 μg voriconazole disk using disk diffusion method as recommend by CLSI/NCCLS M44-A. Disk test plates were automatically read and results were recoded with the BIOMIC Image Analysis System. The equivalent MICs were automatically calculated by the BIOMIC System software. Results The proportion of Candida albicans and non-Candida albicans （e. g. Candida glabrata） in the total fungal isolates did not change significantly from 2001 to 2005. The susceptibility rate of C. albicans to fluconazole and voriconazole were stable during 2001 and 2005. However, the resistance to fluconazole and voriconazole increased variably in C. glabrata and other non- Candida albicans fungal isolates during the same period. Conclusions The voriconazole demonstrated higher activity against all yeast species in comparison with fluconazole. The increasing resistance to fluconazole and voriconazole in non C. albicans fungal isolates including C. glabrata suggests the importance of surveillance of fungal resistance in Candida isolates.