Trends in antifungal drug susceptibility of Cryptococcus neoformans isolates in the United States:: 1992 to 1994 and 1996 to 1998
Trends in antifungal drug susceptibility of Cryptococcus neoformans isolates in the United States:: 1992 to 1994 and 1996 to 1998
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DOI：
10.1128/aac.45.11.3065-3069.2001
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发表时间：
2001-11-01
影响因子：
4.9
通讯作者：
Warnock, DW
中科院分区：
文献类型：
--
作者：
Brandt, ME;Pfaller, MA;Warnock, DW
测定了 1992 年至 1994 年（368 个分离株）和 1996 年至 1998 年（364 个分离株）通过主动实验室监测获得的两个新型隐球菌分离株的抗真菌药物敏感性。氟康唑、伊曲康唑、氟胞嘧啶的MIC采用国家临床实验室标准委员会肉汤微量稀释法测定；两性霉素 B MIC 通过 E 测试确定。我们的结果表明，从 1992 年到 1998 年，这四种抗真菌药物的 MIC 范围、抑制 50% 分离株的 MIC（MIC(50)s）和 MIC（90）没有变化。此外，极少数分离株表现出升高的 MIC，表明存在体外耐药性。 2 株两性霉素 B 的 MIC 升高（大于或等于 2 μg/ml），14 株氟胞嘧啶的 MIC 升高（大于或等于 32 μg/ml）。在唑类药物中，8个分离株的氟康唑MIC升高（大于或等于64μg/ml），45个分离株的伊曲康唑MIC升高（大于或等于1μg/ml）。对 71 名患者的 172 个系列分离株的分析显示，氟康唑 MIC 随着时间的推移几乎没有变化。对于来自 58 名患者（系列病例的 82%）的分离株，氟康唑 MIC 没有变化或发生了两倍变化。相比之下，对于来自 7 名患者（系列病例的 12%）的分离株，MIC 至少增加了四倍。对于来自另一名患者的分离株，氟康唑 MIC 在 1 个月内下降了 32 倍。我们的结论是，新型隐球菌的体外抗真菌药物耐药性仍然不常见，并且在过去十年中没有随时间发生显着变化。
The antifungal drug susceptibilities of two collections of Cryptococcus neoformans isolates obtained through active laboratory-based surveillance from 1992 to 1994 (368 isolates) and 1996 to 1998 (364 isolates) were determined. The MICs of fluconazole, itraconazole, and flucytosine were determined by the National Committee for Clinical Laboratory Standards broth microdilution method; amphotericin B MICs were determined by the E-test. Our results showed that the MIC ranges, the MICs at which 50% of isolates are inhibited (MIC(50)s), and the MIC(90)s of these four antifungal agents did not change from 1992 to 1998. In addition, very small numbers of isolates showed elevated MICs suggestive of in vitro resistance. The MICs of amphotericin B were elevated (greater than or equal to2 mug/ml) for 2 isolates, and the MICs of flucytosine were elevated (greater than or equal to 32 mug/ml) for 14 isolates. Among the azoles, the fluconazole MIC was elevated (greater than or equal to 64 mug/ml) for 8 isolates and the itraconazole MIC (greater than or equal to1 mug/ml) was elevated for 45 isolates. Analysis of 172 serial isolates from 71 patients showed little change in the fluconazole MIC over time. For isolates from 58 patients (82% of serial cases) there was either no change or a twofold change in the fluconazole MIC. In contrast, for isolates from seven patients (12% of serial cases) the increase in the MIC was at least fourfold. For isolates from another patient there was a 32-fold decrease in the fluconazole MIC over a 1-month period. We conclude that in vitro resistance to antifungal agents remains uncommon in C. neoformans and has not significantly changed with time during the past decade.