Espinel-Ingroff A, Bartlett M, Chaturvedi V, Ghannoum M, Hazen K C, Pfaller M A, Rinaldi M, Walsh T J
Medical Mycology Research Laboratory, Medical College of Virginia of Virginia Commonwealth University, Richmond, Virginia 23298-0049, USA.
Antimicrob Agents Chemother. 2001 Jun;45(6):1828-35. doi: 10.1128/AAC.45.6.1828-1835.2001.
The most important role of susceptibility testing is to identify potentially resistant isolates for the agent being evaluated. Standard testing guidelines recently have been proposed for antifungal susceptibility testing of filamentous fungi (molds). This collaborative (eight centers) study evaluated further newly proposed guidelines (NCCLS, proposed standard M38-P, 1998) and other testing conditions for antifungal susceptibility testing of Aspergillus spp. to itraconazole and three new triazoles, posaconazole (SCH56592), ravuconazole (BMS-207147), and voriconazole. MICs of itraconazole, posaconazole, ravuconazole, and voriconazole for 15 selected isolates of three species of Aspergillus (A. fumigatus, A. flavus, and A. terreus) with well documented in vitro, clinical, or animal data were determined in each center by using four medium formulations (standard RPMI-1640 [RPMI], RPMI with 2% dextrose, antibiotic medium 3 [M3], and M3 with 2% dextrose) and two criteria of MIC determination (complete [MIC-0s] and prominent [MIC-2s] growth inhibition) at 24, 48, and 72 h. The highest reproducibility (92 to 99%) was seen with the standard RPMI and M3 media. Moreover, the distinction between itraconazole-resistant (MICs of >8 microg/ml for clinically resistant strains) and -susceptible (MICs of 0.03 to 1 microg/ml) isolates, as well as between a voriconazole-resistant laboratory mutant and other isolates (voriconazole MICs of 2 to >8 versus 0.12 to 2 microg/ml), was more consistently evident with the standard RPMI medium and when MIC-0s were determined at 48 h. These results provide further refinement of the testing guidelines for susceptibility testing of Aspergillus spp. and warrant consideration for inclusion in the future NCCLS document M38-A.
药敏试验最重要的作用是识别针对所评估药物可能耐药的菌株。最近已提出丝状真菌（霉菌）抗真菌药敏试验的标准检测指南。这项协作性（八个中心）研究进一步评估了新提出的指南（NCCLS，建议标准M38-P，1998）以及其他检测条件，用于曲霉属对伊曲康唑和三种新型三唑类药物（泊沙康唑[SCH56592]、雷夫康唑[BMS-207147]和伏立康唑）的抗真菌药敏试验。在每个中心，使用四种培养基配方（标准RPMI-1640[RPMI]、含2%葡萄糖的RPMI、3号抗生素培养基[M3]和含2%葡萄糖的M3）以及两种MIC测定标准（完全[MIC-0s]和显著[MIC-2s]生长抑制），在24、48和72小时测定了15株选定的三种曲霉（烟曲霉、黄曲霉和土曲霉）菌株对伊曲康唑、泊沙康唑、雷夫康唑和伏立康唑的MIC，这些菌株具有充分记录的体外、临床或动物数据。标准RPMI和M3培养基的重现性最高（92%至99%）。此外，对于伊曲康唑耐药（临床耐药菌株的MIC>8μg/ml）和敏感（MIC为0.03至1μg/ml）菌株之间的区分，以及伏立康唑耐药实验室突变株与其他菌株（伏立康唑MIC为2至>8μg/ml对0.12至2μg/ml）之间的区分，在标准RPMI培养基以及在48小时测定MIC-0s时更为一致明显。这些结果进一步完善了曲霉属药敏试验的检测指南，值得考虑纳入未来的NCCLS文件M38-A。
