不同抗真菌药物对艾滋病合并马尔尼菲篮状菌病临床疗效及体外药敏试验结果分析

目的观察艾滋病合并马尔尼菲篮状菌病患者体外真菌药敏结果和不同抗真菌治疗方案的疗效。方法将酵母相马尔尼菲篮状菌调成菌悬液并转移至药敏培养基中混匀,然后将混匀的酵母菌悬浮液接种到ATBTMFUNGUS 3酵母样真菌敏感性检测试纸条上孵育,可以通过肉眼判读杯状凹中酵母菌的生长情况,获得两性霉素B、伊曲康唑、伏立康唑、氟康唑、氟胞嘧啶的最小抑菌浓度(minimum inhibitory concentration,MIC);同时临床观察不同抗真菌药物治疗的疗效。结果84株马尔尼菲篮状菌均显示两性霉素B MIC<0.5 mg/L,伊曲康唑MIC<0.125 mg/L,伏立康唑MIC<0.06 mg/L。73株(86.90%)马尔尼菲篮状菌显示氟康唑MIC≥1 mg/L。69株(82.14%)马尔尼菲篮状菌显示氟胞嘧啶MIC≥4 mg/L。药敏结果显示马尔尼菲篮状菌对两性霉素B、伊曲康唑和伏立康唑的MIC均处于低水平,而对氟康唑和氟胞嘧啶MIC均处于高水平。84例患者中有7例未接受抗真菌治疗者均死亡,77例患者接受了抗真菌治疗,其中74例治疗好转,治疗好转率96.10%。两性霉素B治疗组好转率96.88%,伏立康唑治疗组好转率92.31%,两组比较差异无统计学意义(P=0.43)。结论艾滋病合并马尔尼菲篮状菌病可以选择两性霉素B、伏立康唑和伊曲康唑治疗,不推荐选择氟康唑和氟胞嘧啶治疗。

Analysis of in Vitro Sensitivity and Therapeutic Effect of Different Antifungals Drugs in AIDS Patients with Talaromycosis

Objective To study the antifungal effect on talaromycosis in vitro and the efficacy of different antifungal therapies in AIDS patients with talaromycosis.Methods Susceptibility of Talaroyces marneffei(T.marneffei)to antifungal agents was assessed using ATBTMFUNGUS 3 test kits.The growth of yeast was checked,and the minimum inhibitory concentrations(MICs)of amphotericin B,itraconazole,voriconazole,fluconazole and flucytosine were obtained.At the same time,we estimated the therapeutic effect of different antifungal drugs in the clinics.Results The MICs of amphotericin B<0.5 mg/L,itraconazole<0.125 mg/L and voriconazole<0.06 mg/L were detected in 84 strains of T.Marneffei.The MICs of fluconazole in 73 strains(86.90%)of T.Marneffei were≥1 mg/L.The MICs of flucytosine in 69 strains(82.14%)of T.Marneffei were≥4 mg/L.Drug susceptibility test showed that the MICs of amphotericin B,itraconazole and voriconazole to T.Marneffei were low,while the MICs of fluconazole and flucytosine were high.Among the 84 patients,7 patients who did not receive antifungal treatment died.Seventy-seven patients received antifungal treatment,74(96.10%)of them improved.The improvement rate of the amphotericin B-treated group was 96.88%,and that of the voriconazole-treated group was 92.31%.There was no significant difference in the improvement rate between the two groups(P=0.43).Conclusion Amphotericin B,voriconazole and itraconazole can be used in the treatment of AIDS patients with Talaromycosis,but fluconazole and flucytosine are not recommended.