耐伊曲康唑烟曲霉临床分离株对四种抗真菌药物的敏感性测定

目的 测定耐伊曲康唑烟曲霉临床株对4种抗真菌药物的敏感性。方法 自一例对伊曲康唑无效的肺曲霉球患者体内系列分离6株烟曲霉。利用美国临床实验室标准化研究所（CLSI）的微量液基稀释法M38-A方案和E-test法测定6株烟曲霉临床分离株对两性霉素B、卡泊芬净、米卡芬净、伏立康唑和伊曲康唑的敏感性。结果 6株烟曲霉中，2株对伊曲康唑的最低抑菌浓度（MIC）为 0.5 μg/mL，其他4株的MIC均 ＞ 16 μg/mL；两性霉素B和伏立康唑对6株烟曲霉的MIC分别为1 μg/mL和0.25 ~ 1 μg/mL，卡泊芬净和米卡芬净对6株烟曲霉的最低有效浓度均 ≤0.03 μg/mL。E-test法测定结果也显示，卡泊芬净和伏立康唑对6株烟曲霉有良好的抑制活性。结论 耐伊曲康唑烟曲霉临床株对两性霉素B、卡泊芬净、米卡芬净和伏立康唑敏感。

Antifungal susceptibility testing of clinical isolates of itraconazole-resistant Aspergillus fumigatus to four antifungal drugs

Objective To evaluate the susceptibility of itraconazole-resistant Aspergillus fumigatus isolates to four other antifungal drugs. Methods Six strains of Aspergillus fumigatus were serially isolated from a patient with lung aspergilloma, who was resistant to itraconazole therapy. Clinical Laboratory Standard Institute broth microdilution method M38-A and E-test were applied to test the susceptibility of A.fumigatus strains to amphotericin B, itraconazole, voriconazole, caspofungin and micafungin. Results With M38-A method, the minimal inhibitory concentration （MIC） of itraconazole was 0.5 μg/mL for 2 strains and more than 16 μg/mL for the other 4 strains; the MICs of amphotericin B and voriconazole were 1 μg/mL and 0.25 - 1 μg/mL respectively for all the 6 strains; and the minimal effective concentration （MEC） of caspofungin and micafungin were no more than 0.03 μg/mL for all the 6 strains. Moreover, E-test results also revealed that caspofungin and voriconazole had a good antifungal activity against all the strains, including the 4 itraconazole-resistant ones. Conclusion The itraconazole-resistant A. fumigatus strains isolated from a patient with lung aspergilloma are susceptible to amphotericin B, voriconazole, caspofungin, and micafungin.