80株新生隐球菌的体外药物敏感试验分析

目的 了解近10年来自我国不同地区分离的新生隐球菌临床株对5种抗真菌药物的体外敏感性.方法 采用美国临床和实验室标准化研究所(CLSI)推荐的微量液基稀释法(M27-A2)检测两性霉素B、氟康唑、氟胞嘧啶、伊曲康唑和伏立康唑对1998年至2007年分离自上海、广东、福建,北京等地区的80株新生隐球菌临床株的最低抑菌浓度(MIC).采用Kruskal-Wallis秩和检验进行统计学分析.结果 两性霉素B、氟康哗、氟胞嘧啶、伊曲康唑和伏立康唑对受试菌的MIC50分别为0.5、4、2、0.25和≤0.031 3 mg/L,MIC<,90>分别为1、8、4、0.5和0.062 5 mg/L.受试菌株中,3株对氟胞嘧啶耐药,占3.8%,4株对伊曲康唑耐药,占5.0%,未发现对其余3种药物的耐药株;所有受试菌株对两性霉素B和伏立康唑均敏感.不同分离年份组菌株对5种抗真菌药物MIC值比较,差异均无统计学意义(χ2值分别为0.500,2.687,2.211,2.660,0.677,P>0.05).结论 新型隐球菌临床株对5种抗真菌药物的敏感性高,仅少数菌株对氟胞嘧啶和伊曲康唑耐药.不同时期分离菌株的药物敏感性无明显差异.

In vitro antifungal susceptibility of 80 Cryptococcus neoformans isolates

Objective To determine in vitro drug susceptibility to five antifungal agents of clinical Cryptococcus neoformans strains isolated from different areas of China in recent ten years. Methods Eighty clinical isolates of Cryptococcus neoformans were isolated from Shanghai, Guangdong, Fujian, Beijing and some other areas of China from 1998 to 2007. The minimal inhibitory concentrations (MIC) of the isolates to five antifungal agents, including amphotericin B, fluconazole, flucytosine, itraconazole and voriconazole, were determined using broth microdilution procedure (document M27-A2) recommended by the Clinical and Laboratory Standards Institute (CLSI). Kruskal-Wallis rank sum test was employed for the statistical analysis. Results The MIC50 of the Cryptococcus neoforrnans isolates tested for amphotericin B, fluconazole, flucytosine, itraconazole and voriconazole were 0.5, 4, 2, 0.25 and ≤0.031 3 mg/L, respectively; and the MIC<,90> of the isolates tested for the above antifungal agents were 1, 8, 4, 0.5 and 0.062 5 mg/L, respectively. Among the tested isolates, 3 (3.8 %) were resistant to flucytosine, 4 (5.0 %) were resistant to itraconazole. All isolates were susceptible to amphotericin B and voriconazole. There was no significant difference in MIC of the strains isolated from any particular years to the five agents (χ2=0.500,2.687,2.211, 2.660,0.677,P>0.05). Conclusions The Cryptococcusneoformans isolates are highly susceptible to the five antifungal agents, while a few strains are resistant to flucytosine or itraconazole. The drug susceptibilities of the strains isolated from particular years are similar.