抗真菌药物单独与联合应用对烟曲霉菌的体外抗菌活性研究

目的了解常用抗丝状真菌药物对烟曲霉菌的体外抗菌活性,指导临床对侵袭性曲霉病的合理用药。方法药敏试验方法采用美国临床实验室标准化研究所(CLSI)制定的用于产丝孢状真菌的体外药敏方案(M38-A),按规定的标准进行。结果4种抗丝状真菌药物卡泊芬净(CBF)、伏立康唑(VRC)、两性霉素B(AMB)、伊曲康唑(ICZ)对32株烟曲霉菌的MIC90分别为2.0mg/L、8.0mg/L、4.0mg/L、4.0mg/L,联合药物AMB VRC、AMB ICZ、VRC ICZ的部分抑菌浓度(FIC)指数<1,分别为50.0%、43.75%、18.75%。结论烟曲霉菌对AMB和ICZ的耐药性不断升高。对于预防和治疗烟曲霉菌的轻、中度感染,VRC和ICZ可作为经验用药或初始治疗的首选药物;对中、重度的烟曲霉菌感染,应首选卡泊芬净治疗,并根据患者个体和病情发展情况合理调整抗真菌药物。

Study of in vitro antifungal activity of single or combination application of antifungal drugs against Aspergillus fumigatus

Objective To evaluate the in vitro antifungal activity of anti-filamentous fungal drugs against Aspergillus fumigatus,and instruct rational application of antifungal drugs anainst invasive aspergillomycosis.Methods The minimum inhibitory concentration(MIC) was determined according to American Clinical Laboratory Standard Institute M38-A scheme.Results The MIC90 of caspofung(CBF),voriconazole(VRC), amphotericin(AMB)and itraconazole(ICZ) against 32 strains of Aspergillus fumigatus was 2.0 mg/L,8.0 mg/L,4.0 mg/L and 4.0mg/L respectively.The fractional inhibitory concentration(FIC) index<1 of AMB VRC,AMB ICZ,VRC ICZ were 50.0%, 43.75% and 18.75% respectively.Conclusion The bacterial resistance to AMB and ICZ is rising gradually.VRC and ICZ can be used as empirical or initial treatment drugs for preventing and treating moderate or slight Aspergillus fumigatus infection,and CBF is the first choice for treating moderate or severe Apergillus fumigatus infection.Antifungal drugs should be adjusted according to patients' disease condition.