Correlation of fluconazole MICs with clinical outcome in Cryptococcal infection
Correlation of fluconazole MICs with clinical outcome in Cryptococcal infection
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DOI：
10.1128/aac.44.6.1544-1548.2000
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发表时间：
2000-06-01
影响因子：
4.9
通讯作者：
Espinel-Ingroff, A
中科院分区：
文献类型：
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作者：
Aller, AI;Martin-Mazuelos, E;Espinel-Ingroff, A
我们对28株新生隐球菌进行了氟康唑体外药敏试验，并与氟康唑维持治疗后的临床结果进行了相关性分析。对来自25名患者（24名AIDS患者）的新生儿进行了测试。MIC通过肉汤微量稀释技术通过遵循美国国家临床标准委员会（NCCLS）文件M27-A中描述的修改的指南来确定，例如，使用酵母氮基培养基和10（4）CFU/ml的最终接种物。在孵育48小时后，通过免疫测定法获得的50%分离株被抑制的氟康唑MIC（MIC 50）和MIC 90分别为1 μ g/ml和16 μ g/ml。在所研究的25名患者中，4名死于活动性隐球菌病，2名死于其他原因，在5名感染氟康唑MIC大于或等于16 μ g/ml的分离株的患者中观察到治疗失败。这些患者中有4名先前患有口咽念珠菌病（OPC）; 3名先前患有隐球菌感染，并且所有5名治疗失败的患者在血清或脑脊液中具有高隐球菌抗原滴度（滴度，>1：4，000）。虽然18例对氟康唑治疗有反应的患者中有14例以前有OPC感染，但他们每人只有一次隐球菌感染。提示氟康唑维持治疗的临床效果可能更好，当感染念珠菌时。新形式菌株被较低浓度的氟康唑根除抑制（MIC，
We have correlated the in vitro results of testing the susceptibility of Cryptococcus neoformans to fluconazole with the clinical outcome after fluconazole maintenance therapy in patients,vith AIDS-associated cryptococcal disease, A total of 28 isolates of C. neoformans from 25 patients (24 AIDS patients) were tested. The MICs were determined by the broth microdilution technique by following the modified guidelines described in National Committee for Clinical Standards (NCCLS) document M27-A, e.g., use of yeast nitrogen base medium and a final inoculum of 10(4) CFU/ml, The fluconazole MIC at which 50% of isolates are inhibited (MIC50) and MIC90, obtained spectrophotometrically after 48 h of incubation, a ere I and 16 mu g/ml, respectively, Of the 25 patients studied, 4 died of active cryptococcal disease and 2 died of other causes, Therapeutic failure was observed in five patients who were infected with isolates for which fluconazole MICs were greater than or equal to 16 mu g/ml. Four of these patients had previously had oropharyngeal candidiasis (OPC); three had previously had episodes of cryptococcal infection, and all five treatment failure patients had high cryptococcal antigen titers in either serum or cerebrospinal fluid (titers, >1:4,000). Although 14 of the 18 patients who responded to fluconazole therapy had previously had OPC infections, they each had only a single episode of cryptococcal infection. It appears that the clinical outcome after fluconazole maintenance therapy may be better when the infecting C. neoformans strain is inhibited by lower concentrations of fluconazole for eradication (MICs,