Amphotericin B in vitro resistance is associated with fatal Aspergillus flavus infection
Amphotericin B in vitro resistance is associated with fatal Aspergillus flavus infection
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DOI：
10.3109/13693786.2012.684154
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发表时间：
2012-11-01
期刊：
影响因子：
2.9
通讯作者：
Ranque, Stephane
中科院分区：
文献类型：
--
作者：
Hadrich, Ines;Makni, Fattouma;Ranque, Stephane
体外抗真菌药敏结果是否与侵袭性曲霉病（IA）患者的预后相关仍有争议。本研究旨在测试IA患者的结局是否与体外敏感性结果相关。为此，我们确定了37个黄曲霉菌分离株的体外敏感性阿替霉素B（AMB）从14例血液恶性肿瘤确诊或可能IA，其中13人与AMB脱氧胆酸盐治疗。通过Etest测定最小抑菌浓度（MIC），如果MIC ≥ 2 mg/l，则将分离株分别归类为体外敏感（AMB-S）或耐药（AMB-R）< 2 or >。患者死亡与原发病、抗真菌治疗和AMB-RA感染的关系。使用广义估计方程Logistic回归检验黄度。我们在31/37（84%）分离株中评估了AMB-R。AMB治疗组中，AMB-S和AMB-RA感染者的生存率分别为2/3（67%）和2/9（22%）。黄色。AMB-RA感染。黄病毒株（P = 0.014）和急性髓细胞白血病（P = 0.036）是死亡的独立预测因子。我们的研究结果表明，体外耐药预测A。AMB治疗黄侵袭性疾病。非培养微生物方法的最新进展不应阻碍获得体外抗真菌药敏结果的努力，这对于IA患者选择抗真菌治疗至关重要。
Whether in vitro antifungal susceptibility findings correlate with the outcome of patients with invasive aspergillosis (IA) remains debated. This study aimed to test whether IA patients' outcomes were associated with in vitro susceptibility results. To do so, we determined the in vitro susceptibility to amphotericin B (AMB) of 37 Aspergillus flavus isolates from 14 patients with haematological malignancies diagnosed with proven or probable IA, of which 13 were treated with AMB deoxycholate. Minimal inhibitory concentrations (MICs) were determined by Etest with the isolates classified as in vitro sensitive (AMB-S) or resistant (AMB-R) if their MICs were < 2 or >= 2 mg/l, respectively. The association of the patients' death with primary disease, administered antifungal treatment, and infection with AMB-R A. flavus was tested using generalized estimating equations logistic regression. We assessed AMB-R in 31/37 (84%) isolates. In the patients treated with AMB, the survival rate was 2/3 (67%) and 2/9 (22%) for those infected with AMB-S or AMB-R A. flavus, respectively. Both infection with AMB-R A. flavus (P = 0.014) strain and acute myelocytic leukaemia as the underlying primary disease (P = 0.036) were independent predictors of death. Our findings indicate that in vitro resistance predicts a poor outcome in patients with A. flavus invasive disease treated with AMB. Recent advances in non-culture-based microbiological methods should not discourage efforts to obtain in vitro antifungal susceptibility results, which are critical for the choice of antifungal therapy in patients with IA.