评价3种体外敏感试验方法检测念珠菌对氟康唑和伏立康唑的敏感性  

Comparison of four different methods in testing the in vitro susceptibility of Candida to fluconazole and voriconazole

作　　者：刘锦燕[1] 项明洁[2] 张华[1] 陈华[1] 倪语星[3] 

机构地区：[1]上海交通大学医学院附属瑞金医院卢湾分院放免检验科,上海200020 [2]上海交通大学医学院附属瑞金医院卢湾分院检验科,上海200020 [3]上海交通大学医学院附属瑞金医院微生物科

出　　处：《中国感染与化疗杂志》2011年第5期364-370,共7页Chinese Journal of Infection and Chemotherapy

基　　金：上海市卫生局局级课题(No.2009239);上海市卢湾区区卫生局课题(No.08014);上海交通大学医学院科技基金项目(No.09XJ21036)

摘　　要：目的评价3种实验室常用念珠菌体外药敏试验方法在测定氟康唑和伏立康唑对念珠菌的体外活性上的可靠性及实用性。方法应用美国临床实验室标准化委员会微量肉汤稀释法(NCCLS M27-A2),NCCLS念珠菌纸片扩散法(M44-A),丹麦ROSCO纸片扩散法、法国生物梅里埃公司ATB FUNGUS 3药敏试验板条法检测氟康唑和伏立康唑对85株临床分离念珠菌及2株质控菌株的体外抗菌活性。采用SPSS 13.0软件分析结果,比较3种实验室常用药敏试验方法与NCCLS M27-A2微量肉汤稀释法的相关性。结果 3种体外药敏试验方法所得结果分别与M27-A2肉汤微量稀释法进行比较,氟康唑药敏试验结果比对,NCCLS M44-A纸片扩散法一致率为83.5%,ROSCO纸片扩散法一致率为76.4%,ATB FUNGUS 3药敏试验板条法一致率为72.9%;伏立康唑药敏试验结果比对,3种药敏试验方法一致率均为85.9%。结论在检测氟康唑和伏立康唑对常见念珠菌体外抗菌活性的3种方法所得结果与肉汤稀释法存在一定的差异。对部分菌株(尤其是剂量依赖敏感株)需要进一步应用M27-A2肉汤微量稀释法确定其MIC值。各种体外药敏试验结果与临床体内疗效还需进一步研究。Objective To compare the utility of four methods of in vitro susceptibility testing for fluconazole and voriconazole against isolates of Candida（n=85）.Methods The NCCLS M44-A disk diffusion method.ROSCO tablets method,ATB FUNGUS 3 susceptibility test were compared with reference NCCLS M27-A2 broth microdilution method in testing the in vitro susceptibility of 85 clinical Candida isolates and 2 quality control strains to fluconazole and voriconazole.The correlation between the results obtained by these four methods was analyzed with SPSS 13.0 software.Results The agreement between the three methods and the reference broth microdilution method in terms of the susceptibility to fluconazole was：NCCLS M44-A disk diffusion method（83.5%）,ROSCO tablets method（76.4%）,ATB FUNGUS 3 susceptibility test（72.9%）.The agreement between each of the three methods and the reference broth microdilution method in terms of the susceptibility to voriconazole was all 85.9%.Conclusions The results showed that there was some discrepancy between the results of fluconazole obtained by the three common laboratory methods and those obtained by broth microdilution method.The susceptibility of some Candida isolates（especially those with dose-dependent sensitivity） should be confirmed by NCCLS M27-A2 broth microdilution method.The relationship between these in vitro susceptibility testing results and in vivo therapeutic effect should be further investigated.

关 键 词：念珠菌 氟康唑 伏立康唑 药物敏感性试验 

分 类 号：R446.5[医药卫生—诊断学]