中国大陆地区Fonsecaea临床分离株的体外抗真菌药物敏感性特征  

Antifungal drug susceptibility of Fonsecaea spp.

作　　者：王会伟 姜伟伟 徐媛 李颖芳 李航 朱信霖 陈天杨 王启龙 陈敏 潘炜华 廖万清 WANG Huiwei;JIANG Weiwei;XU yuan;LI Yingfang;LI Hang;ZHU Xinlin;CHEN Tianyang;Wang Qilong;CHEN Min;PAN Weihua;LIAO Wanqing(Department of Dermatology, Shanghai Changzheng Hospital, Naval Military Medical University, Shanghai 200003, China;Key Laboratory of Molecular Biology of Medical Fungi, Shanghai 200003, China;Hangzhou Third People's Hospital, Hangzhou 310009, China;Shanghai Dermatology Hospital, Shanghai 200443, China;69218 Military Hospital, Kashi 844799, China)

机构地区：[1]海军军医大学上海长征医院皮肤科,上海200003 [2]上海市医学真菌分子生物学重点实验室,上海200003 [3]杭州市第三人民医院皮肤科,杭州310009 [4]上海市皮肤病医院皮肤科,上海200443 [5]69218部队医院,喀什844799

出　　处：《中国真菌学杂志》2022年第2期132-136,共5页Chinese Journal of Mycology

基　　金：国家自然重点项目"中国人群高发的难治性暗色真菌感染的生态学和进化起源研究"(81720108026)。

摘　　要：目的通过体外药敏试验研究分离自我国的着色霉属(Fonsecaea spp.)临床菌株对抗真菌药物敏感性特征,为制定精准抗真菌治疗方案提供依据。方法采用美国临床实验室标准化委员会推荐的丝状菌标准的肉汤微量稀释法(CLSI M38-A2法),利用11种临床抗真菌药物,对32株Fonsecaea spp.临床分离株进行的体外抗真菌敏感性测试,总结相关菌株的体外抗真菌药敏特征。同时,对迄今为止国内外83个已报道的Fonsecaea spp.病例的菌株药敏与临床特征进行系统性回顾分析。结果泊沙康唑(MIC_(50)=0.25μg/mL,MIC_(90)=0.5μg/mL)、艾沙康唑(MIC_(50)=0.25μg/mL,MIC_(90)=0.5μg/mL)、伏立康唑(MIC_(50)=0.125μg/mL,MIC_(90)=0.25μg/mL)等二代唑类抗真菌药对Fonsecaea spp.临床株的抗菌活性最高,而两性霉素B(MIC_(50)=4μg/mL;MIC_(90)=8μg/mL)、氟康唑(MIC_(50)=8μg/mL,MIC_(90)>8μg/mL)、棘白菌素类(MEC_(50)=8μg/mL,MEC_(90)>8μg/mL)的抗菌活性较低。结论Fonsecaea spp.3个常见的致病菌种对抗真菌药的敏感性和临床预后一致,优先推荐二代唑类药物(泊沙康唑、艾沙康唑、伏立康唑等)作为抗真菌治疗方案。有关Fonsecaea spp.临床分离菌株的体外联合药敏特征值得进一步研究。Objective To study Fonsecaea spp.strains isolated from China to understand the characteristics of antifungal drug susceptibility and to provide data basis for the development of precise antifungal drug regimens for dark fungal diseases caused by Fonsecaea spp.infections in China.Methods Using the broth microdilution method(CLSI M38-A2 method)recommended by the American Clinical Laboratory Standardization Committee for filamentous fungi,in this study,in vitro drug sensitivity tests were conducted on 32 clinical isolates of Fonsecaea spp.against 11 clinical antifungal drugs.We also systematically analyzed the drug sensitivity characteristics and clinical prognosis of 83 reported cases of Fonsecaea spp.infection in China and abroad.Results Fonsecaea spp.was most sensitive to the antifungal activity of second-generation azole antifungal drugs,including posaconazole(MIC_(50)=0.25μg/mL,MIC_(90)=0.5μg/mL),esaconazole(MIC_(50)=0.25μg/mL,MIC_(90)=0.5μg/mL),voriconazole(MIC_(50)=0.125μg/mL,MIC_(90)=0.25μg/mL).While amphotericin B(MIC_(50)=4μg/mL,MIC_(90)=8μg/mL),fluconazole(MIC_(50)=8μg/mL,MIC_(90)>8μg/mL),and echinocandins(MEC_(50)=8μg/mL,MEC_(90)>8μg/mL)had lower antifungal activity against Fonsecaea spp.Conclusion For the antifungal treatment of Fonsecaea spp.infection,it is advisable to give preference to second-generation azoles(posaconazole,esaconazole,voriconazole,etc.).The in vitro combined drug sensitivity profile of clinical isolates of Fonsecaea spp.warrants further study.

关 键 词：暗色真菌病 着色霉 体外药物敏感性试验 抗真菌药物 

分 类 号：R379.9[医药卫生—病原生物学]