肺部曲霉菌属感染的临床与耐药性研究  

Pulmonary Infection due to Aspergillus:A Clinical and Drug Resistance Investigation

作　　者：周铁丽[1] 彭婷婷[1] 李玉萍[1] 吴玲剑[1] 王赛芳[1] 李超[1] 周武[1] 

机构地区：[1]温州医学院附属第一医院,浙江温州325000

出　　处：《中华医院感染学杂志》2007年第10期1309-1311,共3页Chinese Journal of Nosocomiology

摘　　要：目的检测6种常用抗真菌药物对曲霉菌属的体外抗菌活性,探讨肺部曲霉菌属感染的相关因素与预后。方法采用Etest法测定伊曲康唑、酮康唑、5-氟胞嘧啶、卡泊芬净、两性霉素B和氟康唑对18株曲霉的最低抑菌浓度(MIC);用回顾性调查的方法对肺部曲霉菌属感染患者进行分析。结果卡泊芬净、伊曲康唑、两性霉素B对曲霉菌属的MIC90分别为0.25、1.0、2.0μg/ml,酮康唑、5-氟胞嘧啶和氟康唑的MIC90分别≥32、32、256μg/ml;卡泊芬净对各种曲霉菌属的抑菌效果均较好;伊曲康唑对烟曲霉、黄曲霉的体外抗菌活性高于两性霉素B,两性霉素B对黑曲霉的体外抗菌活性高于伊曲康唑;大多肺部曲霉菌属感染患者有高龄、基础疾病等。结论高龄、基础疾病、广谱抗菌药物使用是曲霉菌属感染的主要原因,肺部曲霉菌属感染病死率高;伊曲康唑、卡泊芬净和两性霉素B对曲霉菌属的体外抑菌效果较好,但不同药物对不同种类曲霉菌属抗菌活性不同,实验室将曲菌鉴定到种并进行体外抗真菌药敏感试验对临床具有重要的指导意义。OBJECTIVE To detect the susceptibility of Aspergillus to antifungal agents, and describe the correlated factors and outcome of pulmonary aspergillosis. METHODS Etest method was used to test the minimum inhibitory concentration（MIC） of itroconazole, ketoconazole, flucytosine, caspofungin, amphotericin B and fluconazole against Aspergillus. Eighteen pulmonary aspergillosis cases were retrospectively analyzed. RESULTS The MIC90 of caspofungin, itroconazole, and amphotericin B were 0. 25, 1. 0, and 2. 0μg/ml, respectively. The MIC90 of ketoconazole, flucytosine and fluconazole were 32, 32, and 256μg/ml, respectively. Caspofungin had higher in vitro antimicrobial activity to all Aspergillus ; itroconazole had higher in vitro antimicrobial activity to A. fumigatus and A. flavus than amphotericin B, but amphotericin B had higher in vitro antimicrobial activity to A. niger than itroconazole. Most cases were aging and had various underlying diseases. CONCLUSIONS Aging, underlying diseases and plentiful use of antibiotics are the most factors inducing Aspergillus infections, the mortality of pulmonary aspergillosis is high; itroconazole, caspofungin and amphotericin B had higher in vitro antimicrobial activity to Aspergillus, but various types antifungal agents have different in vitro antimicrobial activity against various types of Aspergillus. It is necessary to identify Aspergillus to species and perform antifungal susceptibility test among infected cases.

关 键 词：曲霉菌属 肺部感染 抗真菌药物 体外抗菌活性 浓度梯度法 

分 类 号：R379.5[医药卫生—病原生物学]