Antifungal susceptibilities of Candida species causing vulvovaginitis and epidemiology of recurrent cases
Antifungal susceptibilities of Candida species causing vulvovaginitis and epidemiology of recurrent cases
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DOI：
10.1128/jcm.43.5.2155-2162.2005
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发表时间：
2005-05-01
影响因子：
9.4
通讯作者：
Pfaller, MA
中科院分区：
文献类型：
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作者：
Richter, SS;Galask, RP;Pfaller, MA
由于很少进行培养，因此有关引起外阴阴道念珠菌病的酵母菌的抗真菌敏感性的数据有限。对1998年1月至2001年3月从429名疑似外阴阴道念珠菌病患者收集的阴道酵母分离物进行了药敏试验。对 84 名多次培养呈阳性的患者的图表进行了审查。 593 种酵母分离株为白色念珠菌 (n = 420)、光滑念珠菌 (n = 112)、近平滑念珠菌 (n = 30)、克柔念珠菌 (n = 12)、酿酒酵母 (n = 9)、热带念珠菌 (n = 8)、卢西塔尼亚念珠菌 (n = 1) 和毛孢子菌属 sp. （n = 1）。从 27 个培养物中分离出多个表明混合感染的物种。很少观察到对氟康唑和氟胞嘧啶的耐药性（3.7%和3.0%）； 16.2%的分离株对伊曲康唑耐药（MIC≥1μg/ml）。四种咪唑（益康唑、克霉唑、咪康唑和酮康唑）具有活性：94.3% 至 98.5% 在 = 16 μg/ml 时敏感）仅在光滑念珠菌（15.2% 耐药 [R]、51.8% 敏感，剂量依赖性 [S-DD]）、近平滑念珠菌 (3.3% S-DD)、酿酒酵母中观察到（11.1% S-DD）和克柔梭菌（50% S-DD，41.7% R，被认为本质上对氟康唑耐药）。在光滑念珠菌 (74.1%)、克柔念珠菌 (58.3%)、酿酒酵母 (55.6%) 和近平滑念珠菌 (3.4%) 中观察到对伊曲康唑的耐药性。在 84 名反复发作的患者中，非白色念珠菌属更为常见（42% 对 20%）。仅在一名近平滑念珠菌患者中观察到氟康唑 MIC 增加了 2:>= 4 倍。这些结果支持使用唑类药物对无并发症的念珠菌性外阴阴道炎进行经验性治疗。复发性发作更常由非白色念珠菌属物种引起，唑类药物不太可能有效。
There are limited data regarding the antifungal susceptibility of yeast causing vulvovaginal candidiasis, since cultures are rarely performed. Susceptibility testing was performed on vaginal yeast isolates collected from January 1998 to March 2001 from 429 patients with suspected vulvovaginal candidiasis. The charts of 84 patients with multiple positive cultures were reviewed. The 593 yeast isolates were Candida albicans (n = 420), Candida glabrata (n = 112), Candida parapsilosis (n = 30), Candida krusei (n = 12), Saccharomyces cerevisiae (n = 9), Candida tropicalis (n = 8), Candida lusitaniae (n = 1), and Trichosporon sp. (n = 1). Multiple species suggesting mixed infection were isolated from 27 cultures. Resistance to fluconazole and flucytosine was observed infrequently (3.7% and 3.0%); 16.2% of isolates were resistant to itraconazole (MIC >= 1 mu g/ml). The four imidazoles (econazole, clotrimazole, miconazole, and ketoconazole) were active: 94.3 to 98.5% were susceptible at = 16 mu g/ml) were only observed in C. glabrata (15.2% resistant [R], 51.8% susceptible-dose dependent [S-DD]), C. parapsilosis (3.3% S-DD), S. cerevisiae (11.1% S-DD), and C. krusei (50% S-DD, 41.7% R, considered intrinsically fluconazole resistant). Resistance to itraconazole was observed among C. glabrata (74.1%), C. krusei (58.3%), S. cerevisiae (55.6%), and C. parapsilosis (3.4%). Among 84 patients with recurrent episodes, non-albicans species were more common (42% versus 20%). A 2:>= 4-fold rise in fluconazole MIC was observed in only one patient with C. parapsilosis. These results support the use of azoles for empirical therapy of uncomplicated candidal vulvovaginitis. Recurrent episodes are more often caused by non-albicans species, for which azole agents are less likely to be effective.