云南省艾滋病患者分离新生隐球菌的药物敏感性检测与分析
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摘要
目的了解云南省艾滋病患者分离新生隐球菌的药物敏感性情况。方法采用比色微量稀释法,对2007年8月—2018年7月云南省传染病医院住院艾滋病患者标本分离的304株新生隐球菌进行药敏试验,检测6种常用抗隐球菌药物的敏感性。结果药敏结果显示:两性霉素B、5-氟胞嘧啶、氟康唑、伏立康唑、伊曲康唑及泊沙康唑MIC_(50)分别为1、2、4、0.03、0.06、0.12μg/mL,MIC_(90)分别为1、4、8、0.06、0.12、0.25μg/mL,几何均数分别为0.75、2.32、3.28、0.039、0.053、0.09μg/mL。在6种抗真菌药物中,新生隐球菌对伏立康唑和两性霉素B的耐药率为1.32%,5-氟胞嘧啶的耐药率为0.33%,未发现对伊曲康唑和氟康唑产生耐药的菌株。结论云南省艾滋病患者分离的新生隐球菌对不同药物敏感性有差异,可为临床选药提供参考。
Objective To investigate antimicrobial susceptibility of Cryptococcus neoformans(C.neoformans) isolated from patients with acquired immunodeficiency syndrome(AIDS)in Yunnan Province.Methods 304 strains of C.neoformans isolated from AIDS patients in Yunnan Infectious Diseases Hospital between August 2007 and July 2018 were performed antimicrobial susceptibility testing by colorimetric microdilution method,susceptibility to 6 commonly used anti-cryptococcal agents was detected.Results Antimicrobial susceptibility testing results showed that MIC_(50) of amphotericin B,5-fluorocytosine,fluconazole,voriconazole,itraconazole,and posaconazole were 1,2,4,0.03,0.06,and 0.12μg/mL respectively,and the MIC_(90) were 1,4,8,0.06,0.12,and 0.25μg/mL respectively,with geometric mean values of 0.75,2.32,3.28,0.039,0.053,and 0.09μg/mL respectively.Among6 antifungal agents,resistance rate of C.neoformans to voriconazole and amphotericin B was 1.32%,and to 5-fluorocytosine was 0.33%,no strain was found to be resistant to itraconazole and fluconazole.Conclusion C.neoformans isolated from AIDS patients in Yunnan Province have different susceptibility to different antimicrobial agents,which can provide reference for clinical antimicrobial choice.
Objective To investigate antimicrobial susceptibility of Cryptococcus neoformans(C.neoformans) isolated from patients with acquired immunodeficiency syndrome(AIDS)in Yunnan Province.Methods 304 strains of C.neoformans isolated from AIDS patients in Yunnan Infectious Diseases Hospital between August 2007 and July 2018 were performed antimicrobial susceptibility testing by colorimetric microdilution method,susceptibility to 6 commonly used anti-cryptococcal agents was detected.Results Antimicrobial susceptibility testing results showed that MIC_(50) of amphotericin B,5-fluorocytosine,fluconazole,voriconazole,itraconazole,and posaconazole were 1,2,4,0.03,0.06,and 0.12μg/mL respectively,and the MIC_(90) were 1,4,8,0.06,0.12,and 0.25μg/mL respectively,with geometric mean values of 0.75,2.32,3.28,0.039,0.053,and 0.09μg/mL respectively.Among6 antifungal agents,resistance rate of C.neoformans to voriconazole and amphotericin B was 1.32%,and to 5-fluorocytosine was 0.33%,no strain was found to be resistant to itraconazole and fluconazole.Conclusion C.neoformans isolated from AIDS patients in Yunnan Province have different susceptibility to different antimicrobial agents,which can provide reference for clinical antimicrobial choice.
引文
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[18]Bertout S,Drakulovski P,Kouanfack C,et al.Genotyping and antifungal susceptibility testing of Cryptococcus neoformans isolates from Cameroonian HIV-positive adult patients[J].Clin Microbiol Infect,2013,8(19):763-769.
[19]Smith KD,Achan B,Hullsiek KH,et al.Increased antifungal drug resistance in clinical isolates of Cryptococcus neoformans in Uganda[J].Antimicrob Agents Chemother,2015,59(12):7197-7204.
[20]Espinel-Ingroff A,Aller AI,Canton E,et al.Cryptococcus neoformans-Cryptococcus gattii species complex:an international study of wild-type susceptibility endpoint distributions and epidemiological cutoff values for fluconazole,itraconazole,posaconazole,and voriconazole[J].Antimicrob Agents Chemother,2012,56(11):5898-5906.
[21]Espinel-Ingroff A,Chowdhary A,Cuenca-Estrella M,et al.Cryptococcus neoformans-Cryptococcus gattii species complex:an international study of wild-type susceptibility endpoint distributions and epidemiological cutoff values for amphotericin B and flucytosine[J].Antimicrob Agents Chemother,2012,56(6):3107-3113.
[2]卢洪洲.艾滋病及其相关疾病临床路径(2011年版)[M].上海:上海科学技术出版社,2012:127-129.
[3]Córdoba S,Isla MG,Szusz W,et al.Susceptibility profile and epidemiological cut-off values of Cryptococcus neoformans species complex from Argentina[J].Mycoses,2016,59(6):351-356.
[4]尚红,王毓三,申子瑜.全国临床检验操作规程[M].4版.北京:人民卫生出版社,2015:627.
[5]苏汉珍,韦善求,AIDS患者新型隐球菌感染的细菌分布特点及其耐药性分析[J].国际检验医学杂志,2013,4(34):470-471.
[6]张米,雷素云,高丽.艾滋病患者培养检出新型隐球菌的分布特点及其耐药分析[J].世界最新医学信息文摘,2015,(15)2:102-103.
[7]沈珲,邬靖敏.艾滋病病人血液脑脊液骨髓及胸腹水标本病原菌分布与药物敏感性分析[J].中国艾滋病性病,2018,24(3):227-229,264.
[8]范欣,肖盟,王贺,等.新型隐球菌显色微量肉汤稀释法药敏流行病学折点的建立[J].中华医院感染学杂志,2016,26(10):2215-2218.
[9]朱均昊,韩德忞,李莉,等.华东地区新生隐球菌药物敏感性分析[J].检验医学,2016,31(9):761-764.
[10]Andrade-Silva L,Ferreira-Paim K,Mora DJ,et al.Susceptibility profile of clinical and environmental isolates of Cryptococcus neoformans and Cryptococcus gattii in Uberaba,Minas Gerais,Brazil[J].Med Mycol,2013,51(6):635-640.
[11]NiaréK,Paloque L,Ménard S,et al.Multiple phenotypic and genotypic artemisinin sensitivity evaluation of Malian Plasmodium falciparumisolates[J].Am J Trop Med Hyg,2018,98(4):1123-1131.
[12]Chong HS,Dagg R,Malik R,et al.In vitro susceptibility of the yeast pathogen cryptococcus to fluconazole and other azoles varies with molecular genotype[J].Clin Microbiol,2010,11(48):4115-4120.
[13]Dannaoui E,Abdul M,Arpin M,et al.Results obtained with various antifungal susceptibility testing methods do not predict early clinical outcome in patients with cryptococcosis[J].Antimicrob Agents Chemother,2006,50(7):2464-2470.
[14]Illnait-Zaragozi MT,Martínez GF,Curfs-Breuker I,et al.In vitro activity of the new azole isavuconazole(BAL4815)compared with six other antifungal agents against 162 Cryptococcus neoformans isolates from Cuba[J].Antimicrob Agents Chemother,2008,52(4):1580-1582.
[15]Thompson GR3rd,Wiederhold NP,Fothergill AW,et al.Antifungal susceptibilities among different serotypes of Cryptococcus gattii and Cryptococcus neoformans[J].Antimicrob Agents Chemother,2009,53(1):309-311.
[16]章强强,苏逸丹,李莉,等.100株临床分离致病酵母体外药敏试验分析[J].中华皮肤科杂志,2000,33(5):333-335.
[17]王莉,郑锐,前崎繁文,等.新型隐球菌临床分离株体外抗真菌药物的敏感性[J].中国医科大学学报,2003,23(1):74-75.
[18]Bertout S,Drakulovski P,Kouanfack C,et al.Genotyping and antifungal susceptibility testing of Cryptococcus neoformans isolates from Cameroonian HIV-positive adult patients[J].Clin Microbiol Infect,2013,8(19):763-769.
[19]Smith KD,Achan B,Hullsiek KH,et al.Increased antifungal drug resistance in clinical isolates of Cryptococcus neoformans in Uganda[J].Antimicrob Agents Chemother,2015,59(12):7197-7204.
[20]Espinel-Ingroff A,Aller AI,Canton E,et al.Cryptococcus neoformans-Cryptococcus gattii species complex:an international study of wild-type susceptibility endpoint distributions and epidemiological cutoff values for fluconazole,itraconazole,posaconazole,and voriconazole[J].Antimicrob Agents Chemother,2012,56(11):5898-5906.
[21]Espinel-Ingroff A,Chowdhary A,Cuenca-Estrella M,et al.Cryptococcus neoformans-Cryptococcus gattii species complex:an international study of wild-type susceptibility endpoint distributions and epidemiological cutoff values for amphotericin B and flucytosine[J].Antimicrob Agents Chemother,2012,56(6):3107-3113.