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1.
真菌对临床抗真菌药物的耐药机制   总被引:1,自引:0,他引:1  
真菌感染,尤其是深部真菌感染的发病率近年来呈上升趋势,抗真菌药物的大量使用引起了真菌耐药曰益严重,严重影响了抗真菌药物治疗的效果,也增加了危重患者的病死率,因此对真菌耐药机制的研究十分必要.本文依据常用抗真菌药物的药物种类,分别总结论述了近年来真菌耐药机制研究的新进展.  相似文献   

2.
深部真菌耐药性研究进展   总被引:4,自引:0,他引:4  
王建钊  王英  顾军 《世界临床药物》2003,24(12):714-717,724
近年来深部真菌感染的发病率呈上升趋势,耐药菌株的发生也逐渐增多。对唑类抗真菌药物耐药的深部真菌主要为念珠菌,以白色念珠菌最为常见;对两性霉素B耐药的真菌较少见,偶可见某些丝状真菌或酵母菌。确定耐药真菌的方法尚需进一步完善。耐药真菌感染的治疗是一个棘手的临床问题,对耐药机制的深入探讨可为寻找控制耐药真菌感染的最佳策略提供线索。  相似文献   

3.
真菌耐药机制的研究进展   总被引:1,自引:0,他引:1  
陈晓玲  武航海 《中国药房》2007,18(26):2062-2064
目前,治疗全身性真菌感染的药物较为有限,而真菌的耐药性又为临床治疗带来了更大的困难。其中,真菌耐药性的分类与细菌既有相同之处,又有不同之处。传统将真菌耐药现象分为2类:原发性(固有性)耐药,即真菌本身对某些抗真菌药有耐药性;继发性(获得性)耐药,是指应用抗真菌药后通过改变真菌的基因型(暂时性或持续性)使真菌逐步产生耐药性。目前还有第3种分类———临床耐药,即实验室检查时真菌对抗真菌药敏感,但临床上真菌感染经治疗后仍恶化或复发。临床耐药在免疫缺陷患者如中性粒细胞减少、艾滋病(AIDS)等患者中表现较典型,临床治疗过程中…  相似文献   

4.
近年来随着抗真菌药物在临床上使用日益广泛,同时也导致真菌耐药性的迅速发展,耐药真菌感染的治疗已成为一个棘手的临床问题。真菌耐药是多种机制共同作用的结果,不同抗真菌药物的耐药机制不尽相同。对抗真菌药物耐药性的流行病学现状及耐药机制进行深入探讨,从而更好地了解耐药性与临床治疗失败的关系,有助于控制耐药真菌感染。  相似文献   

5.
秦荣华  孙春红 《淮海医药》2008,26(4):344-345
目的分析医院真菌感染及耐药情况。方法对各类临床标本经分离培养,用酵母菌显色琼脂平皿进行鉴定,纸片法进行药敏实验。结果601份临床标本共分离真菌212株,以白色念珠菌为主,各种真菌对7种抗真菌药物均出现不同程度的耐药。结论真菌感染呈上升趋势,并且产生一定的耐药株。  相似文献   

6.
目的 了解性病后前列腺炎患者真菌感染及对 7种抗真菌药物的耐药情况 ,为临床合理使用抗真菌药物提供依据。方法 对 94 3例性病后前列腺炎患者的前列腺液进行真菌培养 ,并对培养出的 99株真菌进行耐药测定。结果 性病后前列腺炎真菌感染总检出率为 10 .5 0 % ,频数依次为白色念珠菌 5 2例(5 2 .5 3% )、近平滑念珠菌 35例 (35 .35 % )、无名念珠菌 10例 (10 .10 % )、其它 2例 (2 .0 2 % )。药敏结果显示 ,99株真菌对 5 -氟胞嘧啶、咪康唑、益康唑、制霉菌素、酮康唑、氟康唑和两性霉素 B的耐药率分别为 4 4 .4 4 %、14 .14 %、2 .0 2 %、1.0 1%、1.0 1%、0和 0。结论 性病后前列腺炎患者真菌感染是一个不能忽视的问题 ,不同菌株的检出率和对 7种抗真菌药物的部分耐药性存在差异。  相似文献   

7.
目的了解肿瘤患者放化疗后真菌感染的菌种分布特征、诱发真菌感染的危险因素及耐药情况,从而有效预防和控制医院真菌感染。方法对2005年1月至2007年12月出院患者,真菌培养阳性病例进行回顾性分析。结果83例医院真菌感染患者中,白色念珠菌最多占70.87%,其次是光滑念珠菌占13.18%;年龄、抗生素的滥用、激素、侵入性操作等是真菌感染的危险因素。药敏结果表明,本组真菌对所试药物伊曲康唑、两性霉素B、制霉菌素、益康啶、酮康啶、咪康唑均有不同程度的耐药,尤其是益康啶、酮康啶,耐药率高达23.4%和26.8%,制霉菌素和咪康唑的耐药率也在12%以上。结论合理应用抗真菌药,防止滥用抗生素,早期根据药敏试验结果来指导用药,是获得预防及控制真菌感染的最佳手段。  相似文献   

8.
目的了解呼吸道真菌感染和药敏测试情况。方法收集患者标本850株对其检出的240株真菌选用常用6种真菌药敏感测试。结果通过痰液涂片及分离培养,白色念珠菌为主要致病菌,对6种抗真菌药均敏感,只有克柔念珠菌对氟康唑耐药。结论临床应重视对真菌感染的分离鉴定和药敏测试。  相似文献   

9.
目的了解我院ICU患者真菌感染及其耐药情况。方法对2011年1月至2012年12月我院ICU住院患者的痰液标本的真菌培养及其耐药结果进行回顾性分析。结果真菌检出率由2011年的10.6%升到2012年的25.0%;296株真菌标本中,白色念珠菌占58.1%,热带念珠菌26.4%,光滑念珠菌10.1%。药敏结果显示,两性霉素B没有发现耐药菌株,白色念珠菌和热带念珠菌对抗真菌药物的耐药性较低,光滑念珠菌对伊曲康唑的耐药率在40%以上。结论真菌感染呈上升趋势,特别是免疫力低下的ICU患者,应做到早预防,早治疗,加强对高危患者的真菌培养及药敏试验,合理使用抗真菌药物。  相似文献   

10.
目的分析院内临床念珠菌的耐药情况,为临床提供治疗真菌的正确的依据。方法念珠菌用ATB真菌药敏条进行药敏试验。对5种抗真菌药的耐药情况进行回顾性分析和统计。结果念珠菌对所试验的5种抗真菌药物中的两性霉素B、5-氟胞嘧啶和氟康唑,抗菌效果最好。其耐药性分别是1.4%,1.9%和10.34%,其次为伊曲康唑,其耐药率为11.03%,酮康唑为50.0%。结论目前深部真菌感染对抗真菌药物耐药率有不同程度增加。体外抗真菌活性以两性霉素B及5-氟胞嘧啶最强,是目前治疗念珠菌感染首选药物。氟康唑对白色念珠菌有很强的抗菌活性,可作治疗白色念珠菌所引起的感染。  相似文献   

11.
随着免疫缺陷患者增多、器官移植和环境的日益恶化,真菌病的发生率正逐年上升,真菌的耐药性也日益严重,研究新型抗真菌药物和新的治疗途径已成为国内外研究的热点。对于真菌病的治疗,化学治疗是目前临床上的主要手段,而光动力治疗是新兴的方法。本文将从抗真菌的化学治疗药物和光动力治疗药物两个方面分析和总结抗真菌药物的研究现状和发展前景。  相似文献   

12.
Fungal cell wall inhibitors: emphasis on clinical aspects   总被引:3,自引:0,他引:3  
Invasive fungal infections, mainly caused by Candida and Aspergillus species, are an emerging cause of morbidity and mortality among all categories of immunocompromised patients. Currently available antifungal agents, both polyenes, flucytosine and (tri)azoles are hampered by serious infusion- or drug-related toxicity, by hazardous drug-drug interactions, or by pharmacokinetic problems and by the development of resistance, in vitro as well as in vivo. In recent years, several companies have become interested in antifungal drug development and have launched new compounds into preclinical and clinical trials. Some of these agents target the fungal cell wall in stead of the cell membrane. They exert their fungicidal action through inhibition of the synthesis of critical compounds of that fungal cell wall, not present in mammalian cells. Exciting and promising agents include inhibitors of beta-(1,3)-D-glucan synthase and inhibitors of chitin synthase. These drugs appear well tolerated in Phase I-II studies and will soon enter Phase III studies. This review wants to provide the clinical framework for assessing the utility of these agents compared to existing antifungals, thereby focusing on invasive fungal disease and emphasising the changing fungal epidemiology and susceptibility in immunocompromised hosts.  相似文献   

13.
Over the last 30 years or so, the incidence of invasive fungal infections in man has risen dramatically. Patients that become severely immunocompromised because of underlying diseases such as leukemia or recently, acquired immunodeficiency syndrome or patients who undergo cancer chemotherapy or organ transplantation, are particularly susceptible to opportunistic fungal infections. Although Candida species continue to be the major pathogenic fungi in these patients, cryptococcosis, aspergillosis, and coccidioidomycosis, among others, have become increasingly important mycoses. Antifungal drugs currently being used in clinic include polyene antibiotics, azole derivatives and 5-fluorocytosine. With the exception of the latter, all other drugs possess mechanisms of action aimed at disrupting the integrity of the fungal cell membrane by either interfering with the biosynthesis of membrane sterols or by inhibiting sterol functions. However, one significant obstacle preventing successful antifungal therapy is the dramatic increase in drug resistance, especially against azole antimycotics. Among the major mechanisms by which fungi invoke drug resistance is the overexpession of extrusion pumps able to facilitate the efflux of cytotoxic drugs from the cell thus leading to decreased drug accumulation and diminished concentrations. Since the initial observations that azole resistance by fungi may be caused by overexpression of multidrug efflux transporter genes, significant advances have been achieved primarily with Saccharomyces cerevisiae and Candida albicans. The purpose of this review is to discuss various aspects of multidrug resistance in fungi such as antifungal drug mechanisms of action and fungal molecular genetics in the context of targeted drug discovery. The role that membrane transporter proteins play in drug resistance in various species of Candida, Aspergillus and Cryptococcus will be address in more detail, as will be their importance as selective drug targets in the design of novel antifungal agents.  相似文献   

14.
Emerging fungal infections represent a serious problem in an immunocompromised host. Rapid developments in in vitro antifungal susceptibility testing and the availability of several new antifungal agents have provided excellent opportunities to treat infections that are caused by various Candida spp. and to some extend by Aspergillus spp. However, recently the epidemiology of fungal infections has significantly changed and several new pathogens have emerged. This article attempts to summarise the available data on the management of emerging infections with fungal infections that have recently gained importance. Updated recommendations on antifungal treatment are also discussed.  相似文献   

15.
16.
The incidence and severity of invasive fungal infections have significantly increased among immunocompromised hosts leading to excessive morbidity and mortality. Several preventative antifungal strategies (prophylaxis, empirical and pre-emptive) have been developed to improve the outcome of these infections. Although effective, these strategies are associated with toxicity, high cost and potential emergence of resistance. An alternative strategy, in the attempt to optimize the use of antifungal agents in preventing fungal infections, is a risk-adjusted approach based on the risk for, and severity of, infection in a given patient. This strategy has the potential to provide patients likely to suffer severe fungal infection the benefits of antifungal agents while avoiding the negative aspects (toxicity, cost and risk of resistance) in patients at low risk for these infections. In this review we focus on this strategy in cancer patients but it may also be applied to other immunocompromised hosts.  相似文献   

17.
The use of antifungal agents, especially the azole class, has increased in parallel with a higher incidence of fungal infections, particularly in immunocompromised patients. This situation has favored the appearance of Candida species, prominent among them C. albicans and C. globrata, with acquired resistance to these agents. This review focuses on the latest developments in investigations of molecular mechanisms contributing to azole resistance. Multiple resistance mechanisms have been described that can coexist in resistant clinical isolates. Understanding resistance mechanisms is of value not only for the design of new antifungal agents but also the development of strategies of overcome or delay the emergence of resistance.  相似文献   

18.
Emerging fungal infections represent a serious problem in an immunocompromised host. Rapid developments in in vitro antifungal susceptibility testing and the availability of several new antifungal agents have provided excellent opportunities to treat infections that are caused by various Candida spp. and to some extend by Aspergillus spp. However, recently the epidemiology of fungal infections has significantly changed and several new pathogens have emerged. This article attempts to summarise the available data on the management of emerging infections with fungal infections that have recently gained importance. Updated recommendations on antifungal treatment are also discussed.  相似文献   

19.
Invasive fungal infections, most commonly candidiasis or aspergillosis, are a major cause of morbidity and mortality among patients with neutropenia. Difficulty in diagnosing invasive fungal infections in these patients complicates decisions regarding pharmacotherapy. Because of the difficult diagnosis and the significant morbidity and mortality of fungal infections in patients with neutropenia, systemic antifungal agents are used as empiric antifungal therapy in patients with febrile neutropenia who are not responding to antibacterial therapy. The pharmacotherapy of invasive fungal infections has evolved rapidly within the past several years as numerous antifungal agents--different formulations of amphotericin B, azoles, and echinocandins--have become available for use as empiric antifungal therapy in patients with febrile neutropenia. Various levels of evidence support the use of these agents for this indication. Their use is limited, however, by drug intolerance, drug interactions, adverse-event profiles, and limited activity with some mold species. Thus, considerations for selecting an antifungal drug for empiric use in patients with febrile neutropenia should include the epidemiology of fungal infections in the individual patient's institution and the specific clinical circumstances of the patient.  相似文献   

20.
In the 1990s, drug resistance has become an important problem in a variety of infectious diseases including human immunodeficiency virus infection, tuberculosis, and other bacterial infections which have profound effects on human health. At the same time, there have been dramatic increase in the incidence of fungal infections, which are probably the result of alterations in immune status associated with the acquired immuno deficiency syndrome epidemic, cancer chemotherapy, and organ and bone marrow transplantation. The rise in the incidence of fungal infections has exacerbated the need for the next generation of antifungal agents, since many of the currently available drugs have undesirable side effects, are ineffective against new or reemerging fungi, or lead to the rapid development of the resistance. This review will focus on the pathogenic yeast Candida albicans, since a large body of work on the factors and mechanism associated with antifungal drug resistance in this organism is reported sufficiently. It will certainly elaborate the probable molecular targets for drug design, discovered to date.  相似文献   

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