烟曲霉临床菌株对体外抗真菌药物的敏感性研究  

Antifungal susceptibility of clinical Aspergillus fumigatus isolates in vitro

作　　者：冀燕芬 张莉莉[1] 邓淑文[2] 韩禹[2] 赵敬军[1] 廖万清[2] 

机构地区：[1]同济大学附属同济医院皮肤科,上海200065 [2]第二军医大学附属长征医院皮肤病与真菌病研究所-上海市医学真菌重点分子生物学实验室,上海200003

出　　处：《同济大学学报（医学版）》2017年第1期74-79,共6页Journal of Tongji University(Medical Science)

基　　金：国家科技重大传染病专项(2013ZX10004612)

摘　　要：目的揭示国内烟曲霉临床分离株对目前常用及新型抗真菌药物敏感性及不同地区烟曲霉对抗真菌药物的敏感性特点。方法实验室保存的分离自2011—2015年中国不同地区的159株临床烟曲霉菌株为试验菌株。采用美国标准化实验室与研究所(CLSI)推荐的M38-A2微量液基稀释法为药敏方法,按规定的标准进行。结果 12种抗真菌药物伊曲康唑(ITC)、伏立康唑(VRC)、泊沙康唑(POS)、里氟康唑(RAV)、艾沙康唑(ISA)、氟康唑(FLC)、米卡芬净(MCF)、阿尼芬净(ANI)、卡泊芬净(CBF)、两性霉素B(AMB)、特比萘芬(TBF)和5-氟胞嘧啶(5-FC)对159株烟曲霉菌的MIC_(90)分别为1、0.5、0.25、0.5、1、64、0.063、0.063、0.5、2、4、64 mg/L。烟曲霉唑类耐药率分别为:ITC为4.4%,ISA和RAV均为3.77%,POS为3.14%,VRC为1.9%。除VRC、FLC和5-FC外,烟曲霉临床分离株对其他9种抗真菌药物的敏感性在不同地区间差异均有统计学意义(P<0.05)。结论三唑类(除FLC外)和棘白菌素类体外抗烟曲霉菌活性较高,优于AMB和TBF;烟曲霉在体外对FLC、5-FC表现为高度耐药。目前我国烟曲霉临床株唑类耐药率相对较低。烟曲霉株体外抗真菌药物的敏感性存在地区差异。Objective To examine in vitro drug susceptibility of clinical isolates of Aspergillus fumigatus from different regions. Methods One hundred and fifty nine clinical isolates of A. fumigatus were collected from different regions of China during the period between 2011 and 2015. The in vitro antifungal susceptibility were determined using the protocol M38-A2 broth-microdilution recommended by Clinical and Laboratory Standards Institute （CLSI）. Results The MIC90 of the 159 isolates of A. fumigatus to itraconazole, voriconazole, posaconazole, isavuconazole, ravuconazole, fluconazole, caspofungin, anidulafungin, micafungin, terbinafine, amphotericin B and flucytosine were 1, 0. 5, 0. 25, 0.5, 1, 64, 0. 063, 0. 063, 0. 5, 2, 4, 64 mg/L respectively. The rates of resistance of A. fumigatus against itraconazole, isavuconazole, ravuconazole, posaconazole and voriconazole were 4. 4%, 3.77%, 3.77%, 3.14%, 1.9% respectively. MIC values of A. fumigatus to most antibiotics were significantly different among the four geographic regions （P 〈 0. 05 ） with the exception of voriconazole, fluconazole and flucytosine. Conclusion Triazoles （excluding fluconazole） and echinocandins show higher activity against A. fumigatus in vitro compared to amphotericin B and terbinafine, while A. fumigatus displays a high resistance to fluconazole and flucytosine. The prevalence of azole resistance is currently low in China. The susceptibility of A. fumigatus varies among different geographic regions.

关 键 词：烟曲霉 抗真菌药物敏感性试验 微量液基稀释法 

分 类 号：R751[医药卫生—皮肤病学与性病学]