纸片扩散法和微量肉汤稀释法检测念珠菌氟康唑和伏立康唑药物敏感性的比较
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摘要
目的评价纸片扩散法与微量肉汤稀释法检测念珠菌对氟康唑和伏立康唑药物敏感性的一致率。方法针对218株侵袭性真菌感染部位分离的念珠菌,分别采用美国临床和实验室标准协会(CLSI)M44-A2纸片扩散法和CLSI M27微量肉汤稀释法进行药物敏感性检测。依据2018年颁布的CLSI M60新的纸片扩散法判定折点,以微量肉汤稀释法为标准评估纸片扩散法测定结果的分类一致率和错误率。结果 2种方法检测白念珠菌、热带念珠菌、近平滑念珠菌和光滑念珠菌氟康唑药物敏感性的一致率分别为97.6%、95.1%、97.4%和90.5%。2种方法在检测白念珠菌、热带念珠菌、近平滑念珠菌和克柔念珠菌伏立康唑敏感性的一致率分别为97.6%、90.2%、97.4%和81.2%。结论纸片扩散法检测念珠菌对氟康唑和伏立康唑的药物敏感性与微量肉汤稀释法一致率较高,是念珠菌药物敏感性测定简便且准确性较高的检测方法,推荐在真菌实验室常规检测或耐药监测网使用。
Objective To compare the CLSI disk diffusion and broth microdilution(BMD)methods for testing susceptibilities of 218 Candida spp.to fluconazole and voriconazole.Methods All the isolates were collected from patients with invasive fungal infections,and were performed susceptibility test according to CLSI M44 A2 and CLSI M27.The categorical agreement(CA)between two methods was evaluated according to the breakpoints described in CLSI M60.Results The CA between KB and BMD for C.albicans,C.tropicalis,C.parapsilosis and C.glabrata to fluconazole was 97.6%,95.1%,97.4% and 90.5%,respectively.The CA between KB and BMD for C.albicans,C.tropicalis,C.parapsilosis and C.krusei to voriconazole was 97.6%,90.2%,97.4%and 81.2%,respectively.Conclusion Disk diffusion method is a simple and accurate method for the detection of Candida susceptibility to fluconazole and voriconazole.It is recommended to be used in routine bacterial laboratory detection or drug resistance monitoring network.
Objective To compare the CLSI disk diffusion and broth microdilution(BMD)methods for testing susceptibilities of 218 Candida spp.to fluconazole and voriconazole.Methods All the isolates were collected from patients with invasive fungal infections,and were performed susceptibility test according to CLSI M44 A2 and CLSI M27.The categorical agreement(CA)between two methods was evaluated according to the breakpoints described in CLSI M60.Results The CA between KB and BMD for C.albicans,C.tropicalis,C.parapsilosis and C.glabrata to fluconazole was 97.6%,95.1%,97.4% and 90.5%,respectively.The CA between KB and BMD for C.albicans,C.tropicalis,C.parapsilosis and C.krusei to voriconazole was 97.6%,90.2%,97.4%and 81.2%,respectively.Conclusion Disk diffusion method is a simple and accurate method for the detection of Candida susceptibility to fluconazole and voriconazole.It is recommended to be used in routine bacterial laboratory detection or drug resistance monitoring network.
引文
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[13]PAPPAS P G,KAUFFMAN C A,ANDES D,et al.Clinical practice guidelines for the management of candidiasis:2009update by the infectious diseases society of America[J].Clin Infect Dis,2009,48(5):503-535.
[14]WANG H,XIAO M,CHEN S C,et al.In vitro susceptibilities of yeast species to fluconazole and voriconazole as determined by the 2010National China hospital invasive fungal surveillance net(CHIF-NET)study[J].J Clin Microbiol,2012,50(12):3952-3959.
[15]PFALLER M,HAZEN K C,MESSER S,et al.Comparison of results of fluconazole disk diffusion testing for Candida species with results from a central reference laboratory in the Artemis global antifungal surveillance program[J].J Clin Microbiol,2004,42(8):3607-3612.
[16]PFALLER M,BOYKEN L,MESSER S,et al.Comparison of results of voriconazole disk diffusion testing for Candida species with results from a central reference laboratory in the Artemis global antifungal surveillance program[J].J Clin Microbiol,2005,43(10):5208-5213.
[17]NOAKE T,KURIYAMA T,WHITE P L,et al.Antifungal susceptibility of candida species using the clinical and laboratory standards institute disk diffusion and broth microdilution methods[J].J Chemotherap,2007,19(3):283-287.
[18]ESPINEL-INGROFF A,CANTON E,GIBBS D,et al.Correlation of Neo-Sensitabs tablet diffusion assay results on three different Agar media with CLSI broth microdilution M27-A2and disk diffusion M44-A results for testing susceptibilities of candida spp.and cryptococcus neoformans to amphotericin B,caspofungin,fluconazole,itraconazole,and voriconazole[J].J Clin Microbiol,2007,45(3):858-864.
[19]PFALLER M A,DIEKEMA D J,GIBBS D L,et al.Results from the ARTEMIS DISK global antifungal surveillance study,1997to 2007:a 10.5-year analysis of susceptibilities of Candida species to fluconazole and voriconazole as determined by CLSI standardized disk diffusion[J].J Clin Microbiol,2010,48(1):1366-1377.
[20]张丽君,王博.念珠菌对临床常用抗真菌药物的耐药性分析[J].临床和实验医学杂志,2012,11(9):694-695.
[2]KONTOYIANNIS D P,MARR K A,PARK B J,et al.Prospective surveillance for invasive fungal infections in hematopoietic stem cell transplant recipients,2001-2006:overview of the Transplant-Associated infection surveillance network(TRANSNET)database[J].Clin Infect Dis,2010,50(8):1091-1100.
[3]PFALLER M A,DIEKEMA D J.Epidemiology of invasive candidiasis:apersistent public health problem[J].Clin Microbiol Rev,2007,20(1):133-163.
[4]WISPLINGHOFF H,EBBERS J,GEURTZ L,et al.Nosocomial bloodstream infections due to Candida spp.in the USA:species distribution,clinical features and antifungal susceptibilities[J].Int J Antimicrob Agents,2014,43(1):78-81.
[5]WENZEL P R.Nosocomial candidemia:risk factors and attributable mortality[J].Clin Infect Dis,1995,20(6):1531-1534.
[6]GAREY K W,REGE M,PAI M P,et al.Time to initiation of fluconazole therapy impacts mortality in patients with candidemia:a multi-institutional study[J].Clin Infect Dis,2006,43(1):25-31.
[7]XIAO M,FAN X,CHEN S C,et al.Antifungal susceptibilities of Candida glabrata species complex,Candida krusei,Candida parapsilosis species complex and Candida tropicalis causing invasive candidiasis in China:3year National surveillance[J].J Antimicrob Chemother,2015,70(3):802-810.
[8]Clinical and Laboratory Standards Institute.Reference method for broth dilution antifungal susceptibility testing of yeasts:CLSI M27[S].4th ed.Wayne,PA:CLSI,2017.
[9]Clinical and Laboratory Standards Institute.Method for antifungal disk diffusion susceptibility testing of yeasts;approved guideline-second edition:CLSI M44-A2[S].Wayne,PA,USA:CLSI,2009.
[10]Clinical and Laboratory Standards Institute.Zone diameter interpretive standards,corresponding minimal inhibitory concentration(MIC)interpretive breakpoints,and quality control limits for antifungal disk diffusion susceptibility testing of yeasts;informational supplement:CLSI M44-S3[S].3rd ed.Wayne,PA,USA:CLSI,2009.
[11]Clinical and Laboratory Standards Institute.Reference method for broth dilution antifungal susceptibility testing of yeasts;Fourth informational supplement:CLSIM27-S4[S].4th ed.Wayne,PA,USA:CLSI,2012.
[12]Clinical and Laboratory Standards Institute.Performance standards for antifungal susceptibility testing of yeasts:CLSI M60[S].Wayne,PA,USA:CLSI,2018.
[13]PAPPAS P G,KAUFFMAN C A,ANDES D,et al.Clinical practice guidelines for the management of candidiasis:2009update by the infectious diseases society of America[J].Clin Infect Dis,2009,48(5):503-535.
[14]WANG H,XIAO M,CHEN S C,et al.In vitro susceptibilities of yeast species to fluconazole and voriconazole as determined by the 2010National China hospital invasive fungal surveillance net(CHIF-NET)study[J].J Clin Microbiol,2012,50(12):3952-3959.
[15]PFALLER M,HAZEN K C,MESSER S,et al.Comparison of results of fluconazole disk diffusion testing for Candida species with results from a central reference laboratory in the Artemis global antifungal surveillance program[J].J Clin Microbiol,2004,42(8):3607-3612.
[16]PFALLER M,BOYKEN L,MESSER S,et al.Comparison of results of voriconazole disk diffusion testing for Candida species with results from a central reference laboratory in the Artemis global antifungal surveillance program[J].J Clin Microbiol,2005,43(10):5208-5213.
[17]NOAKE T,KURIYAMA T,WHITE P L,et al.Antifungal susceptibility of candida species using the clinical and laboratory standards institute disk diffusion and broth microdilution methods[J].J Chemotherap,2007,19(3):283-287.
[18]ESPINEL-INGROFF A,CANTON E,GIBBS D,et al.Correlation of Neo-Sensitabs tablet diffusion assay results on three different Agar media with CLSI broth microdilution M27-A2and disk diffusion M44-A results for testing susceptibilities of candida spp.and cryptococcus neoformans to amphotericin B,caspofungin,fluconazole,itraconazole,and voriconazole[J].J Clin Microbiol,2007,45(3):858-864.
[19]PFALLER M A,DIEKEMA D J,GIBBS D L,et al.Results from the ARTEMIS DISK global antifungal surveillance study,1997to 2007:a 10.5-year analysis of susceptibilities of Candida species to fluconazole and voriconazole as determined by CLSI standardized disk diffusion[J].J Clin Microbiol,2010,48(1):1366-1377.
[20]张丽君,王博.念珠菌对临床常用抗真菌药物的耐药性分析[J].临床和实验医学杂志,2012,11(9):694-695.