Results obtained with various antifungal susceptibility testing methods do not predict early clinical outcome in patients with cryptococcosis
Results obtained with various antifungal susceptibility testing methods do not predict early clinical outcome in patients with cryptococcosis
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DOI：
10.1128/aac.01520-05
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发表时间：
2006-07-01
影响因子：
4.9
通讯作者：
Drorner, F
中科院分区：
文献类型：
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作者：
Dannaoui, E;Abdul, M;Drorner, F
在法国进行的一项多中心前瞻性研究中，采用CLSI法、Etest和酵母菌氮基(YNB)中的微量肉汤稀释法等不同技术，测定了来自连续人类免疫缺陷病毒阳性和阴性患者的新生隐球菌对抗真菌药物氟康唑、两性霉素B和氟胞嘧啶的体外敏感性。在开始抗真菌治疗2周后，评估体外数据与临床结果之间的关系。此外，还确定了菌株血清型与抗真菌药物体外活性的相关性，并对不同方法获得的药敏结果进行了比较。37例患者接受两性霉素B和氟胞嘧啶联合治疗，22例单用两性霉素B治疗，15例单用氟康唑治疗。无论抗真菌药物测试如何，与CLSI方法、Etest或YNB培养液微量稀释法无效的患者相比，从给定治疗无效的患者分离的菌株的MIC值没有升高的趋势。用CLSI或ETEST方法测得的D型菌株对氟康唑和两性霉素B的MIC值均显著低于A型菌株，而氟胞嘧啶的MIC值因血清型不同而无明显差异。这些发现表明，用所用技术测定的新生葡萄球菌的体外抗真菌敏感性不能预测隐球菌病患者的早期临床结果。
The in vitro susceptibilities of Cryptococcus neoformans isolates from consecutive human immunodeficiency virus-positive and -negative patients to the antifungal agents fluconazole, amphotericin B, and flucytosine were determined by different techniques, including the CLSI method, Etest, and broth microdilution in yeast nitrogen base (YNB) medium, during a multicenter prospective study in France. The relationship between the in vitro data and the clinical outcome 2 weeks after the initiation of antifungal therapy was assessed. In addition, the correlation between the strain serotype and the in vitro activities of the antifungals was determined, and the susceptibility results obtained with the different techniques were also compared. Thirty-seven patients received a combination of amphotericin B with flucytosine as first-line therapy, 22 were treated with amphotericin B alone, and 15 received fluconazole alone. Whatever the antifungal tested, there was no trend toward higher MICs for strains isolated from patients who failed to respond to a given therapy compared to those from patients who did not with either the CLSI method, Etest, or broth microdilution in YNB medium. The MICs obtained by the CLSI or Etest method were significantly lower for serotype D strains than for serotype A strains for both fluconazole and amphotericin B, while flucytosine MICs were not different according to serotype. These findings suggest that the in vitro antifungal susceptibility of C. neoformans, as determined with the techniques used, is not able to predict the early clinical outcome in patients with cryptococcosis.