Serena Carolina, Mariné Marçal, Pastor F Javier, Nolard Nicole, Guarro Josep
Unitat de Microbiologia, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Reus, Spain.
J Antimicrob Chemother. 2005 Jun;55(6):1020-3. doi: 10.1093/jac/dki131. Epub 2005 Apr 21.
The infections caused by basidiomycetous yeasts are often difficult to resolve. Combined therapy might be useful in those severe cases where a monotherapy was ineffective. The aim of this study was to evaluate the in vitro activity of combinations of micafungin with amphotericin B or fluconazole, itraconazole, voriconazole and ravuconazole against isolates of Trichosporon, Rhodotorula and Sporobolomyces.
Twenty-seven clinical isolates were tested, i.e. 10 of Trichosporon asahii, two of Trichosporon mucoides, five of Sporobolomyces salmonicolor and 10 of Rhodotorula glutinis. Drug interactions were assessed by the chequerboard technique using the NCCLS microdilution method (M27-A2). The fractional inhibitory concentration index (FICI) was used to classify drug interactions. Results were interpreted as follows: synergy (FICI < or =0.5), no interaction (FICI >0.5 and < or =4.0), or antagonism (FICI >4.0).
Micafungin combined with amphotericin B showed the highest percentage of synergic interactions (78%) followed by micafungin/ravuconazole and micafungin/itraconazole (48% for each), and micafungin/fluconazole and micafungin/voriconazole (34% for each). Antagonism was not observed in any case.
Some of the combinations tested, especially micafungin/amphotericin B, have potential for the treatment of basidiomycetous yeast infections.
担子菌酵母引起的感染通常难以解决。联合治疗可能对那些单一疗法无效的严重病例有用。本研究的目的是评估米卡芬净与两性霉素B或氟康唑、伊曲康唑、伏立康唑和雷夫康唑联合应用对毛孢子菌、红酵母和掷孢酵母分离株的体外活性。
检测了27株临床分离株，即10株阿萨希毛孢子菌、2株黏液毛孢子菌、5株鲑鱼色掷孢酵母和10株黏红酵母。采用美国国家临床实验室标准化委员会（NCCLS）微量稀释法（M27-A2）棋盘法评估药物相互作用。采用分数抑菌浓度指数（FICI）对药物相互作用进行分类。结果解释如下：协同作用（FICI≤0.5）、无相互作用（FICI>0.5且≤4.0）或拮抗作用（FICI>4.0）。
米卡芬净与两性霉素B联合应用显示出最高比例的协同相互作用（78%），其次是米卡芬净/雷夫康唑和米卡芬净/伊曲康唑（各48%），以及米卡芬净/氟康唑和米卡芬净/伏立康唑（各34%）。在任何情况下均未观察到拮抗作用。
所测试的一些联合用药，尤其是米卡芬净/两性霉素B，具有治疗担子菌酵母感染的潜力。
