Conly J, Rennie R, Johnson J, Farah S, Hellman L
Department of Medicine, Royal University Hospital, University of Saskatchewan, Saskatoon, Canada.
J Infect Dis. 1992 Apr;165(4):761-4. doi: 10.1093/infdis/165.4.761.
Although development of resistance in Candida albicans to amphotericin B is considered rare, C. albicans was persistently recovered from a 28-year-old man after a prolonged course of broad-spectrum antimicrobial therapy for a pancreatic abscess. Determination of the MICs of drugs for C. albicans in Sabouraud broth revealed MICs of 2.5 mg/l amphotericin B, greater than 40 mg/l ketoconazole, 2.5 mg/l miconazole, and greater than 40 mg/l 5-fluorocytosine. Synergy testing revealed a MIC of 0.3 mg/l amphotericin B in the presence of 2.5 mg/l 5-fluorocytosine. When intravenous 5-fluorocytosine was added to the patient's antifungal regimen, achieving levels of 125 mg/l, negative blood cultures resulted for the first time. This suggests there may be a clinical use for in vitro synergy testing as an adjunct to guide antifungal therapy for fungemia due to amphotericin B-resistant C. albicans.
尽管白色念珠菌对两性霉素B产生耐药性的情况被认为很少见，但在一名28岁男性接受针对胰腺脓肿的长期广谱抗菌治疗后，持续从其体内分离出白色念珠菌。在沙氏肉汤中测定白色念珠菌的药物MIC值，结果显示两性霉素B的MIC为2.5mg/l，酮康唑大于40mg/l，咪康唑为2.5mg/l，5-氟胞嘧啶大于40mg/l。协同试验显示，在存在2.5mg/l 5-氟胞嘧啶的情况下，两性霉素B的MIC为0.3mg/l。当在患者的抗真菌治疗方案中加入静脉注射的5-氟胞嘧啶，使其达到125mg/l的水平时，首次出现血培养阴性结果。这表明体外协同试验作为辅助手段指导对两性霉素B耐药的白色念珠菌所致真菌血症的抗真菌治疗可能具有临床应用价值。
