Manfredi M, McCullough M J, Polonelli L, Conti S, Al-Karaawi Z M, Vescovi P, Porter S R
Oral Medicine, Division of Infection and Immunity, Eastman Dental Institute, UCL, University of London, London, UK.
Oral Microbiol Immunol. 2006 Jun;21(3):177-82. doi: 10.1111/j.1399-302X.2006.00274.x.
The most common antifungal drugs in current clinical use for the treatment of oral candidosis are polyenes and azoles, mainly used topically. Poor glycaemic control in association with other local factors, such as the presence of oral dental prostheses, salivary pH, salivary flow rate and tobacco habits, may lead to the development of oral candidosis. Topical antifungal agents are frequently used to prevent the development of candidal infections in patients with poor metabolic control, particularly in the elderly wearing dentures. The aim of this study was to assess the antifungal susceptibility of Candida isolates to six antifungal agents using a commercially available kit, Fungitest. The isolated were collected from patients affected by diabetes mellitus from two different geographic localities (London, UK, and Parma, Italy) and from a group of healthy non-diabetic subjects. No differences in antifungal susceptibility to the six agents tested were observed between Candida isolates from diabetic and non-diabetic subjects. However, differences were observed between the two geographically different diabetes mellitus populations. Oral yeast isolates from diabetes mellitus patients in the UK more often displayed resistance or intermediate resistance to fluconazole (P=0.02), miconazole (P<0.0001), and ketoconazole (P=0.01) than did isolates from diabetes mellitus patients in Italy. In addition, more C. albicans isolates were found in diabetic and non-diabetic subjects that were susceptible to fluconazole (P=0.0008 and P=0.01, respectively) than non-albicans isolates. The difference in the antifungal resistance of isolates from the two populations of diabetes mellitus patients may be related to differences in the therapeutic management of candidal infections between the two centres.
目前临床上用于治疗口腔念珠菌病最常用的抗真菌药物是多烯类和唑类，主要用于局部用药。血糖控制不佳与其他局部因素，如口腔假牙的存在、唾液pH值、唾液流速和吸烟习惯等相关，可能会导致口腔念珠菌病的发生。局部抗真菌药物常用于预防代谢控制不佳患者，尤其是佩戴假牙的老年人念珠菌感染的发生。本研究的目的是使用市售试剂盒Fungitest评估念珠菌分离株对六种抗真菌药物的抗真菌敏感性。分离株取自来自两个不同地理位置（英国伦敦和意大利帕尔马）的糖尿病患者以及一组健康的非糖尿病受试者。在糖尿病和非糖尿病受试者的念珠菌分离株之间，未观察到对所测试的六种药物的抗真菌敏感性存在差异。然而，在两个地理位置不同的糖尿病患者群体之间观察到了差异。与意大利糖尿病患者的分离株相比，英国糖尿病患者的口腔酵母菌分离株对氟康唑（P = 0.02）、咪康唑（P < 0.0001）和酮康唑（P = 0.01）更常表现出耐药或中介耐药。此外，在糖尿病和非糖尿病受试者中，白色念珠菌分离株对氟康唑敏感的比例（分别为P = 0.0008和P = 0.01）高于非白色念珠菌分离株。两个糖尿病患者群体分离株抗真菌耐药性的差异可能与两个中心念珠菌感染治疗管理的差异有关。
