国产伏立康唑对临床分离病原真菌体外抗菌活性研究

目的了解国产伏立康唑对北京和我国其他地区临床分离的常见病原真菌体外抗菌活性。方法分别参照CLSIM27-A2和M38-A方案测定伏立康唑对144株酵母和82株产孢丝状真菌的抗菌活性。受试菌株包括念珠菌114株（含氟康唑获得性耐药白念珠菌）、新型隐球菌20株、阿萨希毛孢子菌10株、曲霉62株（含伊曲康唑耐药曲霉及两性霉素B不敏感曲霉）、镰刀菌10株、尖端赛多孢菌10株。结果伏立康唑对念珠菌（不包括氟康唑耐药和剂量依赖敏感白念珠菌）、新型隐球菌、阿萨希毛孢子菌的MIC50≤0．5mg／L、MIC90≤1mg／L；而对氟康唑获得性耐药白念珠菌MIC50和MIC90均〉16mg／L。对曲霉、尖端赛多孢菌的MIC50≤1mg／L、MIC90≤2mg／L，对镰刀菌的MIC50和MIC90分别为4mg／L和〉16mg／L。结论伏立康唑对多数酵母有较强的体外抗菌活性，尤其是对克柔念珠菌和光滑念珠菌等氟康唑天然耐药菌株。该药对多数产孢丝状真菌也有较好的体外抗菌作用，包括伊曲康唑耐药及两性霉素B不敏感的曲霉以及对多种抗真菌药物耐药的尖端赛多孢菌；但其对氟康唑获得性耐药白念珠菌有一定交叉耐药。

In vitro activity of voriconazole against fungal pathogens isolated

Objective The in vitro antifungal activity of a new triazole antifungal derivative voriconazole was assessed against fungal pathogens isolated from Chinese patients. Methods Minimal inhibitory concentration （MIC） of voriconazole was determined for Candida spp. （n = 114）, Cryptococcus neoformans （n = 20）, Trichosporon asahii （n = 10）, Aspergillus spp. （n = 62）, Fusariurn spp. （n = 10） and Scedosporiurn apiosperrnurn （n = 10） according to CLSI （Clinical and Laboratory Standards Institute） M27-A2 and M38-A broth microdilution methods. Results Voriconazole exhibited good antifungal activity against most tested isolates. The MIC50 and MIC90 values of voriconazole against Candida spp. （except fluconazole-resistant C. albicans）, C. neoformans and T. asahii were not higher than 0.5 mg/L and 1 mg/L, respectively. Both the MIC50 and MIC90 values of voriconazole against fluconazole-resistant C. albicans were higher than 16 mg/L. For Aspergillus spp. and S. apiospermum, the MIC50 and MIC90 values of voriconazole were not higher than 1 mg/L and 2 mg/L. For Fusariurn spp. the values were 4 mg/L and 〉16 mg/L respectively. Conclusions Voriconazole is active against most tested isolates, including those resistant to azoles or less susceptible to amphotericin B, such as resistant C. krusei, C. glabrata, A. terreus, S. apiosperrnurn. Cross-resistance among azoles is found in acquired fluconazole-resistant C. albicans isolates.